MEDICARE: MARY WINFIELD RN

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	163WC1500X	Community Health Registered Nurse	093836	LA

General Provider Information

NPI Number	:	1215292495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY WINFIELD RN

Provider Business Mailing Address
First Line	:	685 LOUISIANA AVE
Second Line	:
City	:	PORT ALLEN
State	:	LA
Zip	:	70767-2144
Country	:	US
Telephone Number	:	225-342-7525
Fax Number	:	225-383-3552

Provider Business Practice Location Address
First Line	:	685 LOUISIANA AVE
Second Line	:
City	:	PORT ALLEN
State	:	LA
Zip	:	70767-2144
Country	:	US
Telephone Number	:	225-342-7525
Fax Number	:	225-383-3552

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

Provider Enumeration Date	:	07/12/2012
Last Update Date	:	07/12/2012

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