Healthcare Provider Details

I. General information

NPI: 1013645167
Provider Name (Legal Business Name): ISABELLA WINEMILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 UNIVERSITY BLVD STE 270
SUFFOLK VA
23435-3900
US

IV. Provider business mailing address

1013 UNIVERSITY BLVD STE 270
SUFFOLK VA
23435-3900
US

V. Phone/Fax

Practice location:
  • Phone: 757-335-4755
  • Fax:
Mailing address:
  • Phone: 757-335-4755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number0110-008729
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0110-008729
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: