Healthcare Provider Details

I. General information

NPI: 1376335919
Provider Name (Legal Business Name): MORGAN WYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HEART DR
GREENVILLE NC
27834-8982
US

IV. Provider business mailing address

3821 RACE TRACK RD
ROBERSONVILLE NC
27871-8943
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-0087
  • Fax:
Mailing address:
  • Phone: 252-508-1492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: