MEDICARE: LINDA WINN RN, PHN

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	296052	CA

General Provider Information

NPI Number	:	1790116432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA WINN RN, PHN

Provider Business Mailing Address
First Line	:	PO BOX 877
Second Line	:
City	:	MOUNTAIN RANCH
State	:	CA
Zip	:	95246-0877
Country	:	US
Telephone Number	:	209-754-9790
Fax Number	:

Provider Business Practice Location Address
First Line	:	891 MOUNTAIN RANCH RD
Second Line	:
City	:	SAN ANDREAS
State	:	CA
Zip	:	95249-9713
Country	:	US
Telephone Number	:	209-754-6482
Fax Number	:

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

Provider Enumeration Date	:	12/05/2013
Last Update Date	:	12/05/2013

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