Healthcare Provider Details

I. General information

NPI: 1184670390
Provider Name (Legal Business Name): MARY C WINSHIP CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33355 HEALTH CAMPUS BLVD
AVON OH
44011-1399
US

IV. Provider business mailing address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 440-937-9099
  • Fax: 440-937-9755
Mailing address:
  • Phone: 216-444-6976
  • Fax: 216-635-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License NumberRN131921
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number05993
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: