MEDICARE: MARY ANN WINTERS APRN-CNP

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	163W00000X	Registered Nurse	370672	OH
2	363LF0000X	Family Nurse Practitioner	025784	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	370672	OTHER	OH	NURSING LICENSE

General Provider Information

NPI Number	:	1710334529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANN WINTERS APRN-CNP

Provider Business Mailing Address
First Line	:	3539 ROCKY RIVER DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3933
Country	:	US
Telephone Number	:	330-421-4039
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 W 25TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-3108
Country	:	US
Telephone Number	:	216-387-0297
Fax Number	:

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

Provider Enumeration Date	:	05/22/2016
Last Update Date	:	11/04/2019

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