Provider Demographics
NPI:1962712901
Name:WYNNE, SIOBAN MARY (RN)
Entity type:Individual
Prefix:MS
First Name:SIOBAN
Middle Name:MARY
Last Name:WYNNE
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 1:700 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-6416
Mailing Address - Country:US
Mailing Address - Phone:845-561-3655
Mailing Address - Fax:
Practice Address - Street 1:700 CORPORATE BLVD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-6416
Practice Address - Country:US
Practice Address - Phone:845-561-3655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY438203-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health