Provider Demographics
NPI:1235156258
Name:WYNNE, BRENNA (MD)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:WYNNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:COOPER UNIVERISRY EMERGENCY PHYSICIANS
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2351
Practice Address - Fax:856-968-8272
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA08014100207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1321749OtherAETNA
NJ60025839OtherHORIZON NJ HEALTH
NJ01077790000OtherAMERICHOICE
NJ0109983Medicaid
NJ2751473000OtherAMERIHEALTH/KEYSTON/IBC
NJ5618198OtherCIGNA
NJP00376573OtherRR MEDICARE
NJ2679053OtherUNITED HEALTHCARE
NJP3698442OtherOXFORD
NJ5618198OtherCIGNA