Healthcare Provider Details

I. General information

NPI: 1912127408
Provider Name (Legal Business Name): STEVIE MARIE WINBLAD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 N SENECA ST
VALLEY CENTER KS
67147-8208
US

IV. Provider business mailing address

641 N SENECA ST
VALLEY CENTER KS
67147-8208
US

V. Phone/Fax

Practice location:
  • Phone: 316-755-1511
  • Fax: 316-755-1991
Mailing address:
  • Phone: 316-755-1511
  • Fax: 316-755-1991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-34414
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: