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General NPI Number Information
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NPI Number | 1467642496
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Entity Type | Individual
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Provider Name | HOLLY K. WYNESKI M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 07/12/2018
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Provider Practice Location Address
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Address Line | 128 E MILLTOWN RD STE 205
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City | WOOSTER
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State | OH
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Zip | 44691
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Country | US
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Telephone | 330-685-9920
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Fax | 330-685-9286
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Provider Business Mailing Address
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Address Line | 128 E MILLTOWN RD STE 205
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City | WOOSTER
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State | OH
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Zip | 44691-1276
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Country | US
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Telephone | 330-685-9920
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 35090889
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License Number State | OH
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