Healthcare Provider Details

I. General information

NPI: 1295331155
Provider Name (Legal Business Name): MOLLY RUTH WINKLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 01/19/2022
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CENTURIAN DR STE 110
NEWARK DE
19713-2154
US

IV. Provider business mailing address

1 CENTURIAN DR
NEWARK DE
19713-2137
US

V. Phone/Fax

Practice location:
  • Phone: 302-355-0900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberC5-0011462
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: