| Doctor Name: | ANDREA LYNNE WYDMAN |
| NPI Number: | 1003055757 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | RN130797 |
| Business Practice Address: | 959 Broad Blvd Dayton, OH - 454192029 |
| Business Phone Number: | 9376942931 |
| Business Fax Number: | 9372986388 |
| Mailing Address: | 959 Broad Blvd, DAYTON |
| State: | OH |
| Postal Code: | 454192029 |
| Phone Number: | 9376942931 |
| Fax Number: | 9372986388 |
| NPI Enumeration Date: | 02/19/2009 |
| NPI Last Update Date: | 02/19/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC0400X |
| License Number: | RN130797 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OH |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Case Management |
| Taxonomy Definition: | |