Provider Demographics
NPI:1831329879
Name:WYCKOFF, CAROLYN ANN (LPN)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:WYCKOFF
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:GOLD BAR
Mailing Address - State:WA
Mailing Address - Zip Code:98251-0447
Mailing Address - Country:US
Mailing Address - Phone:425-778-9102
Mailing Address - Fax:
Practice Address - Street 1:16825 48TH AVE W STE 245
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-6406
Practice Address - Country:US
Practice Address - Phone:425-778-9102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00047927164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse