Provider Demographics
NPI:1003566118
Name:WYLIE, JENNIFER (MD, MS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WYLIE
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER BLVD
Mailing Address - Street 2:SURGERY OUTPATIENT CLINIC - 5TH JANEWAY TOWER
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:505-702-1166
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER BLVD.
Practice Address - Street 2:SURGERY OUTPATIENT CLINIC 5TH JANEWAY TOWER
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157
Practice Address - Country:US
Practice Address - Phone:336-716-0423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program