Healthcare Provider Details

I. General information

NPI: 1417168477
Provider Name (Legal Business Name): THERESA M WINNER NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 MAIN ST
BUFFALO NY
14214-2648
US

IV. Provider business mailing address

8411 MAPLEWOOD DR P.O. BOX 317
GASPORT NY
14067-9479
US

V. Phone/Fax

Practice location:
  • Phone: 716-862-1271
  • Fax:
Mailing address:
  • Phone: 716-862-1271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberF350157
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: