Healthcare Provider Details

I. General information

NPI: 1760395206
Provider Name (Legal Business Name): MARY WINKEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 S LINCOLN ST
ENTERPRISE KS
67441-9073
US

IV. Provider business mailing address

318 S LINCOLN ST
ENTERPRISE KS
67441-9073
US

V. Phone/Fax

Practice location:
  • Phone: 785-280-3204
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-320058
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: