Healthcare Provider Details

I. General information

NPI: 1699987396
Provider Name (Legal Business Name): MALINDA WINTERS CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9772 DIAGONAL RD
MANTUA OH
44255-9128
US

IV. Provider business mailing address

26150 BRIARDALE AVE
EUCLID OH
44132-2310
US

V. Phone/Fax

Practice location:
  • Phone: 330-274-2272
  • Fax:
Mailing address:
  • Phone: 330-274-2272
  • Fax: 330-732-2484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number08672
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: