Healthcare Provider Details

I. General information

NPI: 1912058306
Provider Name (Legal Business Name): JEAN A WINSTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11217 TERRA VISTA PKWY UNIT C
RANCHO CUCAMONGA CA
91730-7402
US

IV. Provider business mailing address

11217 TERRA VISTA PKWY UNIT C
RANCHO CUCAMONGA CA
91730-7402
US

V. Phone/Fax

Practice location:
  • Phone: 909-476-9133
  • Fax:
Mailing address:
  • Phone: 909-476-9133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number688672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: