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General NPI Number Information
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NPI Number | 1659928976
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Entity Type | Individual
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Provider Name | NATASHA OLIVIA RENE WYNN AU.D.
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Gender | Female
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Dates
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Enumeration Date | 08/21/2019
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 101 WELLNESS WAY STE 300
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City | MILFORD
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State | DE
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Zip | 19963-4366
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Country | US
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Telephone | 302-393-5009
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Fax | 302-424-9211
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Provider Business Mailing Address
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Address Line | 226 MARINERS WAY
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City | BEAR
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State | DE
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Zip | 19701-2292
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Country | US
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Telephone |
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 02-0000250
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License Number State | DE
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