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MARY WYMAN FNP

Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1265449797

Individual Registrant:
 MARY  WYMAN FNP
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

Contact information for business:
523 N MAIN ST  SEBASTOPOL, CA 95472-3406 US
Tel: 707-869-2849  Fax: 707-869-1477

Registration Information:
NPI: 1265449797
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Family
CANP13614

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
STATE LICENSE NUMBERNP13614CA01
MEDICARE PART BZZZ73222Z01




HEALTH CARE JOBS CA - Page 1



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