Provider Demographics
NPI:1508436668
Name:WYLO MEDICAL TRAINING INSTITUTE DBA/ WYLO MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:WYLO MEDICAL TRAINING INSTITUTE DBA/ WYLO MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF NURSING OFFICER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHENEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOWRY-WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:CNO, BSN-RN
Authorized Official - Phone:843-514-8028
Mailing Address - Street 1:3328 SPRING VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-7062
Mailing Address - Country:US
Mailing Address - Phone:843-514-8028
Mailing Address - Fax:
Practice Address - Street 1:3328 SPRING VALLEY CT
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-7062
Practice Address - Country:US
Practice Address - Phone:843-514-8028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WYLO MEDICAL TRAINING INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-30
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)