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General NPI Number Information
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NPI Number | 1164714440
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Entity Type | Organization
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Legal Business Name | MARY WINBORN PA-C, PC
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Dates
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Enumeration Date | 05/05/2011
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | 1314 POINSETTIA BLVD
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City | DENTON
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State | TX
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Zip | 76208-7551
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Country | US
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Telephone | 469-438-9070
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Fax |
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Provider Business Mailing Address
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Address Line | 1314 POINSETTIA BLVD
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City | DENTON
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State | TX
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Zip | 76208-7551
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Country | US
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Telephone | 469-438-9070
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY WINBORN
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Credential | PA-C
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Telephone | 469-438-9070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA06772
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License Number State | TX
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