MEDICARE: ELISSA MAY 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	106S00000X	Behavior Technician
2	106S00000X	Behavior Technician		NV

General Provider Information

NPI Number	:	1740709468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISSA MAY WINTERS

Provider Business Mailing Address
First Line	:	1966 UNIVERSITY CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6051
Country	:	US
Telephone Number	:	13204203677
Fax Number	:

Provider Business Practice Location Address
First Line	:	1966 UNIVERSITY CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6051
Country	:	US
Telephone Number	:	320-420-3677
Fax Number	:

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

Provider Enumeration Date	:	09/13/2017
Last Update Date	:	09/13/2017

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