Provider Demographics
NPI:1396395471
Name:WYMAN, CHRISTIE
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:
Last Name:WYMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 W STOTLAR ST
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-4408
Mailing Address - Country:US
Mailing Address - Phone:618-713-9432
Mailing Address - Fax:
Practice Address - Street 1:1408 W STOTLAR ST
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-4408
Practice Address - Country:US
Practice Address - Phone:618-713-9432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider