Healthcare Provider Details

I. General information

NPI: 1750510772
Provider Name (Legal Business Name): BENJAMIN CARL WINKLER CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2009
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 SPRING ST
SCARBOROUGH ME
04074-8926
US

IV. Provider business mailing address

190 RIVERSIDE ST SUITE 6B
PORTLAND ME
04103-1073
US

V. Phone/Fax

Practice location:
  • Phone: 207-883-1414
  • Fax:
Mailing address:
  • Phone: 207-661-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberCNP161019
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: