MEDICARE: KENDRA S WINSTON

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	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1710710736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA S WINSTON

Provider Business Mailing Address
First Line	:	1105 W 104TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-3052
Country	:	US
Telephone Number	:	312-401-1508
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 W 104TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-3052
Country	:	US
Telephone Number	:	312-401-1508
Fax Number	:

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

Provider Enumeration Date	:	08/23/2024
Last Update Date	:	08/23/2024

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Directions to “ KENDRA S WINSTON ” Practice Location

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