MEDICARE: NYEIN WINT MULLENNIEX CAA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367H00000X	Anesthesiologist Assistant	1804
2	367H00000X	Anesthesiologist Assistant	AA2017-001	NM

General Provider Information

NPI Number	:	1033528450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NYEIN WINT MULLENNIEX CAA

Provider Business Mailing Address
First Line	:	809 82ND PKWY
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-4607
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 N GATE RD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-5618
Country	:	US
Telephone Number	:	843-272-7232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2014
Last Update Date	:	08/05/2024

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