Healthcare Provider Details

I. General information

NPI: 1336443183
Provider Name (Legal Business Name): WINONA HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 MANKATO AVE
WINONA MN
55987-6435
US

IV. Provider business mailing address

859 MANKATO AVE
WINONA MN
55987-6435
US

V. Phone/Fax

Practice location:
  • Phone: 507-457-4570
  • Fax: 507-474-3284
Mailing address:
  • Phone: 507-457-4570
  • Fax: 507-474-3284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberR 91551-9
License Number StateMN

VIII. Authorized Official

Name: RACHELLE SCHULTZ
Title or Position: CEO
Credential:
Phone: 507-454-3650