Provider Demographics
NPI:1023891587
Name:WYNN, LA-KIRSHA NATE (CNA)
Entity type:Individual
Prefix:MS
First Name:LA-KIRSHA
Middle Name:NATE
Last Name:WYNN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 N UNION AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1710
Mailing Address - Country:US
Mailing Address - Phone:267-973-2231
Mailing Address - Fax:
Practice Address - Street 1:181 N UNION AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-1710
Practice Address - Country:US
Practice Address - Phone:267-973-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
347C00000X
PA928103385H00000X, 374U00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care
No374U00000XNursing Service Related ProvidersHome Health Aide