Healthcare Provider Details

I. General information

NPI: 1235419516
Provider Name (Legal Business Name): JODI WINEMILLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 ORANGE ST
NEW HAVEN CT
06511
US

IV. Provider business mailing address

875 ORANGE ST
NEW HAVEN CT
06511
US

V. Phone/Fax

Practice location:
  • Phone: 619-251-9202
  • Fax: 203-777-8506
Mailing address:
  • Phone: 619-251-9202
  • Fax: 203-777-8506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number000360
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number000360
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number000360
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number000360
License Number StateCT

VIII. Authorized Official

Name: MS. JODI JEAN WINEMILLER
Title or Position: CERTIFIED NURSE MIDWIFE
Credential: MSN, CNM
Phone: 619-251-9202