Healthcare Provider Details

I. General information

NPI: 1215443155
Provider Name (Legal Business Name): MICHAEL WINKLER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 OLD MEADOW RD STE 100
MC LEAN VA
22102-4308
US

IV. Provider business mailing address

4900 SHERIDAN ST
RIVERDALE MD
20737-1128
US

V. Phone/Fax

Practice location:
  • Phone: 703-506-0123
  • Fax: 703-734-1932
Mailing address:
  • Phone: 443-679-8702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR206162
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: