Healthcare Provider Details

I. General information

NPI: 1639524028
Provider Name (Legal Business Name): MISS MEGHAN WYMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 47TH AVE APT 7F
LONG ISLAND CITY NY
11101-5971
US

IV. Provider business mailing address

511 47TH AVE APT 7F
LONG ISLAND CITY NY
11101-5971
US

V. Phone/Fax

Practice location:
  • Phone: 508-868-3517
  • Fax:
Mailing address:
  • Phone: 508-868-3517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number712544-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: