Healthcare Provider Details

I. General information

NPI: 1902025505
Provider Name (Legal Business Name): DRUPATTIE WINTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DRUPATTIE WALTER RN

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NEW MEXICO VA HEALTH CARE SYSTEM 1501 SAN PEDRO DRIVE, SE
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

4744 SHALIMAR DR
COLUMBIA SC
29206-1049
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax:
Mailing address:
  • Phone: 719-321-6853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001163186
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: