Provider Demographics
NPI:1225217383
Name:WYNJA, ELIZABETH JEAN (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JEAN
Last Name:WYNJA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 HOSPITAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640
Mailing Address - Country:US
Mailing Address - Phone:336-846-6322
Mailing Address - Fax:336-846-1702
Practice Address - Street 1:310 HOSPITAL AVENUE
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640
Practice Address - Country:US
Practice Address - Phone:336-846-6322
Practice Address - Fax:336-846-1702
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01118363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical