Provider Demographics
NPI:1144399205
Name:WYNNE, CHRISTINE MICHELE (PA C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MICHELE
Last Name:WYNNE
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 K ST NW
Mailing Address - Street 2:SUITE 512
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1003
Mailing Address - Country:US
Mailing Address - Phone:202-293-3636
Mailing Address - Fax:202-293-0289
Practice Address - Street 1:2021 K ST NW
Practice Address - Street 2:SUITE 512
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1003
Practice Address - Country:US
Practice Address - Phone:202-293-3636
Practice Address - Fax:202-293-0289
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030362207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine