MEDICARE: EMILY LAUREN WINTERS APRN

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	112624	OK

General Provider Information

NPI Number	:	1760947022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY LAUREN WINTERS APRN

Provider Business Mailing Address
First Line	:	19055 STATE HIGHWAY 49
Second Line	:
City	:	MEDICINE PARK
State	:	OK
Zip	:	73557
Country	:	US
Telephone Number	:	580-595-5503
Fax Number	:

Provider Business Practice Location Address
First Line	:	19055 STATE HIGHWAY 49
Second Line	:
City	:	MEDICINE PARK
State	:	OK
Zip	:	73557
Country	:	US
Telephone Number	:	580-595-5503
Fax Number	:

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

Provider Enumeration Date	:	01/31/2019
Last Update Date	:	04/18/2023

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