Most Relevant Information
Provider Data
| NPI Number: | 1003055757 |
| Provider Name: | ANDREA LYNNE WYDMAN RN |
| Entity Type: | Individual |
| Taxonomy Code: | 163WC0400X |
| Specialty: | Registered Nurse |
| License Number: | RN130797 |
Most Important Dates
| Enumeration Date: | 02/19/2009 |
| Last Updated: | 02/19/2009 |
Provider Practice Location
959 BROAD BLVD
DAYTON
OH
454192029
Practice Location Phone/Fax
| Phone: | 9376942931 |
| Fax: | 9372986388 |
Provider Mailing Location
959 BROAD BLVD
DAYTON
OH
454192029
Provider Mailing Phone/Fax
| Phone: | 9376942931 |
| Fax: | 9372986388 |