Healthcare Provider Details

I. General information

NPI: 1508436668
Provider Name (Legal Business Name): WYLO MEDICAL TRAINING INSTITUTE DBA/ WYLO MEDICAL TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3328 SPRING VALLEY CT
GREEN COVE SPRINGS FL
32043-7062
US

IV. Provider business mailing address

3328 SPRING VALLEY CT
GREEN COVE SPRINGS FL
32043-7062
US

V. Phone/Fax

Practice location:
  • Phone: 843-514-8028
  • Fax:
Mailing address:
  • Phone: 843-514-8028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: CHENEL D LOWRY-WYATT
Title or Position: CHIEF NURSING OFFICER, OWNER
Credential: CNO, BSN-RN
Phone: 843-514-8028