Provider Demographics
NPI:1184510703
Name:WYNN, NICHOLAS TRENT
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:TRENT
Last Name:WYNN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 JUNE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2827
Mailing Address - Country:US
Mailing Address - Phone:801-512-4978
Mailing Address - Fax:
Practice Address - Street 1:9825 N 10800 W
Practice Address - Street 2:
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337-9222
Practice Address - Country:US
Practice Address - Phone:801-643-5057
Practice Address - Fax:866-311-6889
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic