Healthcare Provider Details

I. General information

NPI: 1568054195
Provider Name (Legal Business Name): PAULETTE D WINSOR PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 01/27/2022
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 E GUADALUPE RD STE 103
GILBERT AZ
85234-5116
US

IV. Provider business mailing address

4531 N 16TH ST STE 114
PHOENIX AZ
85016-5344
US

V. Phone/Fax

Practice location:
  • Phone: 480-907-6818
  • Fax: 480-907-5181
Mailing address:
  • Phone: 602-266-8700
  • Fax: 602-296-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN253540
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: