MEDICARE: MRS. MOLLY RUTH WINKLER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant
2	363AS0400X	Surgical Physician Assistant
3	405300000X	Prevention Professional	C5-0011462	DE
4	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1295331155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MOLLY RUTH WINKLER PA-C

Provider Business Mailing Address
First Line	:	1 CENTURIAN DR
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19713-2137
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 CENTURIAN DR STE 110
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19713-2154
Country	:	US
Telephone Number	:	302-355-0900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2020
Last Update Date	:	01/19/2022

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Directions to “ MRS. MOLLY RUTH WINKLER PA-C” Practice Location

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