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NPI Code Detail

MEDICARE: BEVERLY WINFREY LPN

MEDICARE: BEVERLY WINFREY LPN
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
1164W00000XLicensed Practical Nurse4703113342MI

General Provider Information

NPI Number : 1497602494
Entity Type Code : Individual
Provider Name (Legal Business Name) : BEVERLY WINFREY LPN
Provider Business Mailing Address
First Line : 6821 MEDBURY ST
Second Line :
City : DETROIT
State : MI
Zip : 48211-3317
Country : US
Telephone Number : 313-922-2222
Fax Number :
Provider Business Practice Location Address
First Line : 6821 MEDBURY ST
Second Line :
City : DETROIT
State : MI
Zip : 48211-3317
Country : US
Telephone Number : 313-922-2222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2026
Last Update Date : 03/11/2026

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Directions to “ BEVERLY WINFREY LPN” Practice Location

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