| Doctor Name: | AMY MARIE WYBENGA |
| NPI Number: | 1093896540 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CRNP |
| License Number: | 1-061747 |
| Business Practice Address: | 564 N Memorial Dr Prattville, AL - 360672132 |
| Business Phone Number: | 3343582010 |
| Business Fax Number: | 3343582013 |
| Mailing Address: | 2257 Taylor Rd, Suite 200 MONTGOMERY |
| State: | AL |
| Postal Code: | 361177790 |
| Phone Number: | 3342709914 |
| Fax Number: | 3342703195 |
| NPI Enumeration Date: | 10/18/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WG0000X |
| License Number: | 1-061747 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | General Practice |
| Taxonomy Definition: | |