Healthcare Provider Details

I. General information

NPI: 1285435628
Provider Name (Legal Business Name): DONNA MARIE WINEBRIMMER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 WELLNESS DR
SUMMERSVILLE WV
26651-5402
US

IV. Provider business mailing address

131 WELLNESS DR
SUMMERSVILLE WV
26651-5402
US

V. Phone/Fax

Practice location:
  • Phone: 304-872-6503
  • Fax: 304-497-2805
Mailing address:
  • Phone: 304-736-3229
  • Fax: 304-497-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number39464
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: