Healthcare Provider Details

I. General information

NPI: 1205032943
Provider Name (Legal Business Name): WINSOME MCNEISH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 CONNECTICUT DR SUITE 5
BURLINGTON NJ
08016-4177
US

IV. Provider business mailing address

9 DODD ST APT A2
BLOOMFIELD NJ
07003-4633
US

V. Phone/Fax

Practice location:
  • Phone: 800-950-6066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR09387200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: