MEDICARE: TRACY DENISE WINTERS

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1578175105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY DENISE WINTERS

Provider Business Mailing Address
First Line	:	4404 83RD CIR N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-2534
Country	:	US
Telephone Number	:	764-443-7052
Fax Number	:

Provider Business Practice Location Address
First Line	:	4404 83RD CIR N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-2534
Country	:	US
Telephone Number	:	764-443-7052
Fax Number	:

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

Provider Enumeration Date	:	08/17/2020
Last Update Date	:	08/17/2020

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