Healthcare Provider Details

I. General information

NPI: 1316306277
Provider Name (Legal Business Name): MARY WINCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY GARDINER

II. Dates (important events)

Enumeration Date: 02/19/2016
Last Update Date: 12/13/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47665 MARGARET BRENT WAY
ST MARY'S CITY MD
20630
US

IV. Provider business mailing address

47665 MARGARET BRENT WAY
ST MARY'S CITY MD
20630
US

V. Phone/Fax

Practice location:
  • Phone: 240-895-4289
  • Fax: 240-895-4937
Mailing address:
  • Phone: 240-895-4289
  • Fax: 240-895-4937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR195682
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License NumberR195682
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: