MEDICARE: MS. CONNIE ELAINE WINES BS, ADN

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	163W00000X	Registered Nurse	4704169941	MI

General Provider Information

NPI Number	:	1356526289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CONNIE ELAINE WINES BS, ADN

Provider Business Mailing Address
First Line	:	900 E NORTH UNION ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-3779
Country	:	US
Telephone Number	:	989-894-2060
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 E NORTH UNION ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-3779
Country	:	US
Telephone Number	:	989-894-2060
Fax Number	:

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

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	01/09/2008

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