MEDICARE: BREANA WINTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	406034	NY

General Provider Information

NPI Number	:	1053155952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANA WINTERS

Provider Business Mailing Address
First Line	:	23 DANDELION DR
Second Line	:
City	:	GANSEVOORT
State	:	NY
Zip	:	12831-3205
Country	:	US
Telephone Number	:	518-879-3871
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 CRESCENT AVE
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-5100
Country	:	US
Telephone Number	:	518-584-3600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	06/24/2024

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