Provider Demographics
NPI:1124780499
Name:WINNER, VICKIE PAZ (NNP-BC)
Entity type:Individual
Prefix:DR
First Name:VICKIE
Middle Name:PAZ
Last Name:WINNER
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:DR
Other - First Name:VICKIE
Other - Middle Name:CAROLYN PAZ
Other - Last Name:WINNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NNP-BC
Mailing Address - Street 1:2817 GIRARD AVE S APT 108
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-5027
Mailing Address - Country:US
Mailing Address - Phone:502-523-7467
Mailing Address - Fax:
Practice Address - Street 1:2525 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4518
Practice Address - Country:US
Practice Address - Phone:502-523-7467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8655363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care