Provider Demographics
NPI:1942409420
Name:LYLE, WYNOGENE SHERRILL (LPN)
Entity Type:Individual
Prefix:
First Name:WYNOGENE
Middle Name:SHERRILL
Last Name:LYLE
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:P. O. BOX 446
Mailing Address - Street 2:
Mailing Address - City:NIXON
Mailing Address - State:NV
Mailing Address - Zip Code:89424
Mailing Address - Country:US
Mailing Address - Phone:775-574-1018
Mailing Address - Fax:775-574-1114
Practice Address - Street 1:705 HWY 446
Practice Address - Street 2:
Practice Address - City:NIXON
Practice Address - State:NV
Practice Address - Zip Code:89424
Practice Address - Country:US
Practice Address - Phone:775-574-1018
Practice Address - Fax:775-574-1114
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLPN06754164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse