Healthcare Provider Details

I. General information

NPI: 1689620874
Provider Name (Legal Business Name): DONNA YVONNE WINTERROWD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 DONALD POWERS DR
MUNSTER IN
46321
US

IV. Provider business mailing address

PO BOX 3539
MUNSTER IN
46321-0539
US

V. Phone/Fax

Practice location:
  • Phone: 219-934-4200
  • Fax: 219-934-6240
Mailing address:
  • Phone: 219-934-4200
  • Fax: 219-934-6240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001950A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: