Healthcare Provider Details

I. General information

NPI: 1700906633
Provider Name (Legal Business Name): WINONA STATE UNIVERSITY STUDENT HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 W MARK ST
WINONA MN
55987-3384
US

IV. Provider business mailing address

175 W MARK ST
WINONA MN
55987-3384
US

V. Phone/Fax

Practice location:
  • Phone: 507-457-5160
  • Fax: 507-457-2326
Mailing address:
  • Phone: 507-457-5160
  • Fax: 507-457-2326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number StateMN

VIII. Authorized Official

Name: MS. DIANE CATHERINE PALM
Title or Position: DIRECTOR OF STUDENT HEALTH SERVICES
Credential: MS, CNP
Phone: 507-457-5160