MEDICARE: NINA LOUISE WYATT CRNP

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	363LF0000X	Family Nurse Practitioner	SP022496	PA
2	363LP2300X	Primary Care Nurse Practitioner	SP022496	PA

General Provider Information

NPI Number	:	1558973180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA LOUISE WYATT CRNP

Provider Business Mailing Address
First Line	:	785 5TH AVE STE 3
Second Line	:
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17201-4232
Country	:	US
Telephone Number	:	717-263-9555
Fax Number	:	717-709-6529

Provider Business Practice Location Address
First Line	:	22 ST PAUL DR
Second Line	:
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17201-1036
Country	:	US
Telephone Number	:	717-264-6511
Fax Number	:	717-264-1081

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

Provider Enumeration Date	:	08/17/2020
Last Update Date	:	05/28/2026

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