Provider Demographics
NPI:1093212011
Name:WYNINGS-KEATY, ERIN MARY (MD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARY
Last Name:WYNINGS-KEATY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MARY
Other - Last Name:WYNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:217 RADIO DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-5805
Mailing Address - Country:US
Mailing Address - Phone:651-702-0750
Mailing Address - Fax:
Practice Address - Street 1:217 RADIO DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-5805
Practice Address - Country:US
Practice Address - Phone:651-702-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI82359207Y00000X
MN74032207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty