Provider Demographics
NPI:1013200880
Name:WYNNE, AMY M (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:WYNNE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6818
Mailing Address - Country:US
Mailing Address - Phone:716-839-0399
Mailing Address - Fax:
Practice Address - Street 1:56 COLUMBIA DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6818
Practice Address - Country:US
Practice Address - Phone:716-839-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY388812-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse