Provider Demographics
NPI:1508188160
Name:WYNDER, ROSLYN TABITHA (LPN)
Entity Type:Individual
Prefix:MS
First Name:ROSLYN
Middle Name:TABITHA
Last Name:WYNDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SCHROEDER ST
Mailing Address - Street 2:APT 76
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-3354
Mailing Address - Country:US
Mailing Address - Phone:914-410-3381
Mailing Address - Fax:
Practice Address - Street 1:5 SCHROEDER ST
Practice Address - Street 2:APT 76
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3354
Practice Address - Country:US
Practice Address - Phone:914-410-3381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237496-1164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse