Basic Information
| Provider Information | |||||||||
| NPI: | 1225249725 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | WYNNE | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3009 WAUGHTOWN ST | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271071634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362938728 | ||||||||
| FaxNumber: | 3362938733 | ||||||||
| Practice Location | |||||||||
| Address1: | 1920 W 1ST ST | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271044220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367162255 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2007 | ||||||||
| LastUpdateDate: | 10/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 2014-00081 | NC | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VG0400X | MD028746E | PA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 208D00000X | 2014-00081 | NC | N | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | 2014-00081 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.