MEDICARE: MRS. STACY LYNN WINTER PAC

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	363AM0700X	Medical Physician Assistant	917	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104866763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACY LYNN WINTER PAC

Provider Business Mailing Address
First Line	:	9576 HIGHWAY 70
Second Line	:
City	:	MINOCQUA
State	:	WI
Zip	:	54548-9067
Country	:	US
Telephone Number	:	715-358-1000
Fax Number	:	715-358-1156

Provider Business Practice Location Address
First Line	:	9576 HIGHWAY 70
Second Line	:
City	:	MINOCQUA
State	:	WI
Zip	:	54548-9067
Country	:	US
Telephone Number	:	715-358-1000
Fax Number	:	715-358-1156

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	06/19/2023

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