Provider Demographics
NPI:1568472256
Name:WYNEGAR, ANN M (PA)
Entity Type:Individual
Prefix:MISS
First Name:ANN
Middle Name:M
Last Name:WYNEGAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:M
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:6940 VAN DORN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2858
Mailing Address - Country:US
Mailing Address - Phone:402-323-8484
Mailing Address - Fax:402-323-8599
Practice Address - Street 1:6940 VAN DORN ST STE 201
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2858
Practice Address - Country:US
Practice Address - Phone:402-323-8484
Practice Address - Fax:402-323-8599
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE987363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant