Provider Demographics
NPI:1285119115
Name:WYNNE, DELICIA LILNEL (LPN)
Entity type:Individual
Prefix:
First Name:DELICIA
Middle Name:LILNEL
Last Name:WYNNE
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 1:100 W COLLINS CT
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-4905
Mailing Address - Country:US
Mailing Address - Phone:856-481-4797
Mailing Address - Fax:856-481-4797
Practice Address - Street 1:100 W COLLINS CT
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-4905
Practice Address - Country:US
Practice Address - Phone:856-481-4797
Practice Address - Fax:856-481-4797
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP06738900164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse