Healthcare Provider Details

I. General information

NPI: 1588110845
Provider Name (Legal Business Name): SAMANTHA WINSOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 SOUTH BAYLEY HAZEN ROAD
RYEGATE VT
05042
US

IV. Provider business mailing address

PO BOX 1595
LYNDONVILLE VT
05851-1595
US

V. Phone/Fax

Practice location:
  • Phone: 802-745-9029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number026.0113941
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: