Provider Demographics
NPI:1306472709
Name:WYNN, BLONDINE YVONNE
Entity type:Individual
Prefix:
First Name:BLONDINE
Middle Name:YVONNE
Last Name:WYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BATTLEGROUND AVE STE 209C
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-8028
Mailing Address - Country:US
Mailing Address - Phone:336-763-1925
Mailing Address - Fax:
Practice Address - Street 1:2812 APT 2G VANSTORY STREET
Practice Address - Street 2:
Practice Address - City:GREESBORO
Practice Address - State:NC
Practice Address - Zip Code:27407
Practice Address - Country:US
Practice Address - Phone:336-508-7968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5824374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide