MEDICARE: DR. AMY BALETTIE WINTER D.P.M.

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	213E00000X	Podiatrist	PO61355692	WA

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	:	1538169701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY BALETTIE WINTER D.P.M.

Provider Business Mailing Address
First Line	:	PO BOX 368
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98507-0368
Country	:	US
Telephone Number	:	360-570-3460
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 CAPITAL MALL DR SW STE A
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-8654
Country	:	US
Telephone Number	:	360-570-3460
Fax Number	:

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	05/18/2023

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