MEDICARE: NICOLE R WINSTON

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1073080339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE R WINSTON

Provider Business Mailing Address
First Line	:	422 NEWBRIDGE TER
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-9112
Country	:	US
Telephone Number	:	804-334-0708
Fax Number	:

Provider Business Practice Location Address
First Line	:	422 NEWBRIDGE TER
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-9112
Country	:	US
Telephone Number	:	804-334-0708
Fax Number	:

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

Provider Enumeration Date	:	10/25/2018
Last Update Date	:	10/25/2018

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Directions to “ NICOLE R WINSTON ” Practice Location

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