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General NPI Number Information
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NPI Number | 1144497082
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Entity Type | Organization
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Legal Business Name | WYNN FAMILY MEDICINE, PLLC
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Dates
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Enumeration Date | 05/09/2008
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Last Update Date | 11/01/2008
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Provider Practice Location Address
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Address Line | 8316 ARLINGTON BLVD SUITE 234
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City | FAIRFAX
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State | VA
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Zip | 22031-5207
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Country | US
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Telephone | 703-560-0300
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Fax | 703-560-8679
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Provider Business Mailing Address
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Address Line | 8316 ARLINGTON BLVD SUITE 234
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City | FAIRFAX
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State | VA
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Zip | 22031-5207
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Country | US
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Telephone | 703-560-0300
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Fax | 703-560-8679
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Authorized Official
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Title or Position | MANAGING OFFICER/OWNER
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Name | DR. ALANCIA CHRISTINE WYNN
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Credential | M.D.
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Telephone | 703-560-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0101054642
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License Number State | VA
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