Provider Demographics
NPI:1194965020
Name:WINTERS, STACIE KRUGER (RN)
Entity type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:KRUGER
Last Name:WINTERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 SOM CENTER RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2350
Mailing Address - Country:US
Mailing Address - Phone:440-229-5822
Mailing Address - Fax:440-995-0222
Practice Address - Street 1:730 SOM CENTER RD STE 240
Practice Address - Street 2:
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-2362
Practice Address - Country:US
Practice Address - Phone:440-229-5822
Practice Address - Fax:440-995-0222
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN172143163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse