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MARY WYMAN FNP
Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1265449797
Individual Registrant: MARY WYMAN FNP
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
16319 THIRD STREET GUERNEVILLE, CA 95446 US
Tel: 707-869-2849 Fax: 707-869-1477
Tel: 707-869-2849 Fax: 707-869-1477
Contact information for business:
523 N MAIN ST SEBASTOPOL, CA 95472-3406 US
Tel: 707-869-2849 Fax: 707-869-1477
Tel: 707-869-2849 Fax: 707-869-1477
Registration Information:
NPI: 1265449797
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Family | CA | NP13614 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| STATE LICENSE NUMBER | NP13614 | CA | 01 |
| MEDICARE PART B | ZZZ73222Z | 01 |
