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NPI Code Detail

MEDICARE: JACQULYNE HELENE SYLVIA WYNNE

MEDICARE: JACQULYNE HELENE SYLVIA WYNNE
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
1207V00000XObstetrics & Gynecology Physician19051CA
2207Q00000XFamily Medicine Physician19051CA

General Provider Information

NPI Number : 1861844367
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQULYNE HELENE SYLVIA WYNNE
Provider Business Mailing Address
First Line : PO BOX 255228
Second Line :
City : SACRAMENTO
State : CA
Zip : 95865-5228
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 965 EL CAMINO AVE
Second Line :
City : SACRAMENTO
State : CA
Zip : 95815-2530
Country : US
Telephone Number : 916-642-1867
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2016
Last Update Date : 10/28/2024

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Directions to “ JACQULYNE HELENE SYLVIA WYNNE ” Practice Location

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