Healthcare Provider Details

I. General information

NPI: 1588576474
Provider Name (Legal Business Name): CECILIA ANTOINETTE WINN BSN-RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CECILIA WAER BSN-RN

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13854 E RED OAKS DR
VAIL AZ
85641-4504
US

IV. Provider business mailing address

13854 E RED OAKS DR
VAIL AZ
85641-4504
US

V. Phone/Fax

Practice location:
  • Phone: 520-954-1175
  • Fax:
Mailing address:
  • Phone: 520-954-1175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number23230656
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: