Healthcare Provider Details

I. General information

NPI: 1386279271
Provider Name (Legal Business Name): ASHLEY WINNEBERGER RN, CARN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 UNION ST
LYNN MA
01901-1353
US

IV. Provider business mailing address

35 FAIRVIEW AVE
LYNN MA
01904-2323
US

V. Phone/Fax

Practice location:
  • Phone: 781-691-7176
  • Fax: 781-586-0280
Mailing address:
  • Phone: 781-346-7532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN2304334
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: