Healthcare Provider Details

I. General information

NPI: 1639191091
Provider Name (Legal Business Name): KATHY A WINZER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 NESPELEM/SANPOIL ST
NESPELEM WA
99155-0071
US

IV. Provider business mailing address

PO BOX 71
NESPELEM WA
99155-0071
US

V. Phone/Fax

Practice location:
  • Phone: 509-634-2900
  • Fax: 509-634-2945
Mailing address:
  • Phone: 509-634-2900
  • Fax: 509-634-2945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberAP30005393
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: