Healthcare Provider Details

I. General information

NPI: 1134582810
Provider Name (Legal Business Name): ROSE DANIELLE WINTER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 40TH ST
LUBBOCK TX
79404-2746
US

IV. Provider business mailing address

5219 CITY BANK PKWY STE 214
LUBBOCK TX
79407-3537
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-9355
  • Fax: 806-743-9363
Mailing address:
  • Phone: 806-761-0333
  • Fax: 806-722-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP130136
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: