Provider Demographics
NPI:1437264116
Name:JOELLEN WYNNE, FNP LLC
Entity Type:Organization
Organization Name:JOELLEN WYNNE, FNP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WYNNE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:503-439-1539
Mailing Address - Street 1:1881 NW 185TH AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6822
Mailing Address - Country:US
Mailing Address - Phone:503-439-1539
Mailing Address - Fax:503-439-8960
Practice Address - Street 1:1881 NW 185TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-6822
Practice Address - Country:US
Practice Address - Phone:503-439-1539
Practice Address - Fax:503-439-8960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty