Provider Demographics
NPI:1770890006
Name:MOONEY WYNDER, TRACY ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:ANN
Last Name:MOONEY WYNDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:ANN
Other - Last Name:MOONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:207 EVERHART ST
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:PA
Mailing Address - Zip Code:18641-2107
Mailing Address - Country:US
Mailing Address - Phone:570-262-8534
Mailing Address - Fax:
Practice Address - Street 1:207 EVERHART ST
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:PA
Practice Address - Zip Code:18641-2107
Practice Address - Country:US
Practice Address - Phone:570-262-8534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN526993L163W00000X, 163WH0200X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN526993LOtherRN
PARN526993LMedicaid