Healthcare Provider Details

I. General information

NPI: 1568655819
Provider Name (Legal Business Name): HEATHER MARIE WINESETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER MARIE PHINNEY

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 E 2ND ST
DULUTH MN
55805-2200
US

IV. Provider business mailing address

1012 E 2ND ST
DULUTH MN
55805-2200
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-7870
  • Fax: 218-249-7801
Mailing address:
  • Phone: 218-249-7870
  • Fax: 218-249-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number50186
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: