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General NPI Number Information
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NPI Number | 1558973180
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Entity Type | Individual
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Provider Name | NINA LOUISE WYATT CRNP
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Gender | Female
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Dates
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Enumeration Date | 08/17/2020
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 22 ST PAUL DR
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City | CHAMBERSBURG
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State | PA
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Zip | 17201-1036
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Country | US
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Telephone | 717-264-6511
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Fax | 717-264-1081
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Provider Business Mailing Address
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Address Line | 785 5TH AVE STE 3
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City | CHAMBERSBURG
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State | PA
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Zip | 17201-4232
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Country | US
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Telephone | 717-263-9555
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Fax | 717-709-6529
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | SP022496
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP022496
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License Number State | PA
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