Provider Demographics
NPI:1154615110
Name:WININGER, BREAHA R (ACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:BREAHA
Middle Name:R
Last Name:WININGER
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:BREAHA
Other - Middle Name:R
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 MARY ST STE 520
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1682
Mailing Address - Country:US
Mailing Address - Phone:812-424-8231
Mailing Address - Fax:812-435-8794
Practice Address - Street 1:520 MARY ST STE 520
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1682
Practice Address - Country:US
Practice Address - Phone:812-424-8231
Practice Address - Fax:812-435-8794
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003649A363LA2100X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201100560Medicaid
IN71003649OtherINDIANA STATE LICENSE
KY7100332240Medicaid
000000977546OtherANTHEM BCBS
000000977546OtherANTHEM BCBS
KY7100332240Medicaid