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General NPI Number Information
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NPI Number | 1407487077
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Entity Type | Individual
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Provider Name | NATALIE RAE WYNN APRN
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Gender | Female
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Dates
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Enumeration Date | 01/31/2020
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 6120 S FORT APACHE RD STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89148-6760
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Country | US
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Telephone | 702-848-4443
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Fax |
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Provider Business Mailing Address
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Address Line | 6120 S FORT APACHE RD STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89148-6760
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Country | US
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Telephone | 702-948-8660
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0000X
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Taxonomy Name | Pain Management Registered Nurse
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License Number | RN46729
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 815950
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License Number State | NV
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