MEDICARE: JUDITH ANN WINHOVEN CNM

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	367A00000X	Advanced Practice Midwife	1155	CA
2	363LW0102X	Women's Health Nurse Practitioner	5554	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000345741	OTHER	OH	BC/BS

General Provider Information

NPI Number	:	1619986460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH ANN WINHOVEN CNM

Provider Business Mailing Address
First Line	:	949 PALM AVE
Second Line	:
City	:	IMPERIAL BEACH
State	:	CA
Zip	:	91932-1503
Country	:	US
Telephone Number	:	619-429-3733
Fax Number	:	619-429-3823

Provider Business Practice Location Address
First Line	:	949 PALM AVE
Second Line	:
City	:	IMPERIAL BEACH
State	:	CA
Zip	:	91932-1503
Country	:	US
Telephone Number	:	619-429-3733
Fax Number	:	619-429-3823

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	11/08/2011

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