Provider Demographics
NPI:1679771554
Name:WYNN, ANDREA LYNN (RN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:WYNN
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 1:233 CLEARLAKE DR W
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-4501
Mailing Address - Country:US
Mailing Address - Phone:615-942-5692
Mailing Address - Fax:
Practice Address - Street 1:1801 S HOLTZCLAW AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-4806
Practice Address - Country:US
Practice Address - Phone:423-634-3886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106023163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical