Provider Demographics
NPI:1669771192
Name:WYNN, SARAH (PA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:WYNN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1025 HARDING MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6315
Mailing Address - Country:US
Mailing Address - Phone:740-383-8993
Mailing Address - Fax:740-387-8320
Practice Address - Street 1:1025 HARDING MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6315
Practice Address - Country:US
Practice Address - Phone:740-383-8993
Practice Address - Fax:740-387-8320
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003245363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant