MEDICARE: MRS. ALICE MAXINE WINDER F.N.P

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	363LF0000X	Family Nurse Practitioner	046941	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700870730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALICE MAXINE WINDER F.N.P

Provider Business Mailing Address
First Line	:	606 MAPLE VALLEY DR
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1976
Country	:	US
Telephone Number	:	573-756-7779
Fax Number	:	573-756-6914

Provider Business Practice Location Address
First Line	:	606 MAPLE VALLEY DR
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1976
Country	:	US
Telephone Number	:	573-756-7779
Fax Number	:	573-756-6914

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	03/22/2011

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Directions to “ MRS. ALICE MAXINE WINDER F.N.P” Practice Location

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