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NPI Code Detail

MEDICARE: LINDA WINN RN, PHN

MEDICARE: LINDA WINN RN, PHN
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
1163W00000XRegistered Nurse296052CA

General Provider Information

NPI Number : 1790116432
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDA WINN RN, PHN
Provider Business Mailing Address
First Line : PO BOX 877
Second Line :
City : MOUNTAIN RANCH
State : CA
Zip : 95246-0877
Country : US
Telephone Number : 209-754-9790
Fax Number :
Provider Business Practice Location Address
First Line : 891 MOUNTAIN RANCH RD
Second Line :
City : SAN ANDREAS
State : CA
Zip : 95249-9713
Country : US
Telephone Number : 209-754-6482
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2013
Last Update Date : 12/05/2013

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