Provider Demographics
NPI:1417167024
Name:WYNN, CAROLYN MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MARIE
Last Name:WYNN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 SECOND AVE
Mailing Address - Street 2:PO BOX 594
Mailing Address - City:OCRACOKE
Mailing Address - State:NC
Mailing Address - Zip Code:27960
Mailing Address - Country:US
Mailing Address - Phone:252-928-3020
Mailing Address - Fax:
Practice Address - Street 1:305 BACK RD.
Practice Address - Street 2:
Practice Address - City:OCRACOKE
Practice Address - State:NC
Practice Address - Zip Code:27960
Practice Address - Country:US
Practice Address - Phone:252-928-1511
Practice Address - Fax:252-928-7391
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC058076163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse