Provider Demographics
NPI:1619458189
Name:PYNE, EMILY WILSON (FNP-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:WILSON
Last Name:PYNE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANNA
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:4801 DORSEY HALL DR STE 140
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7703
Practice Address - Country:US
Practice Address - Phone:410-992-4100
Practice Address - Fax:410-992-4170
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC003619363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily