Healthcare Provider Details

I. General information

NPI: 1053387811
Provider Name (Legal Business Name): WINONA STOLTZFUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SAN MATEO BLVD NE STE 902
ALBUQUERQUE NM
87108-1507
US

IV. Provider business mailing address

300 SAN MATEO BLVD NE STE 902
ALBUQUERQUE NM
87108-1507
US

V. Phone/Fax

Practice location:
  • Phone: 505-222-8684
  • Fax: 505-222-8675
Mailing address:
  • Phone: 505-222-8684
  • Fax: 505-222-8675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2001-110
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number2001-110
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: