Basic Information
| Provider Information | |||||||||
| NPI: | 1528331212 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WYETH | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 311 | ||||||||
| Address2: | |||||||||
| City: | BOLINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949240311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158689675 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1341 S ELISEO DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | GREENBRAE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949042000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154648169 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2012 | ||||||||
| LastUpdateDate: | 02/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN 366938 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.