Provider Demographics
NPI:1306480017
Name:WINTER, AMANDA (RN, RCS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WINTER
Suffix:
Gender:F
Credentials:RN, RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 65TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-3151
Mailing Address - Country:US
Mailing Address - Phone:262-995-4199
Mailing Address - Fax:
Practice Address - Street 1:4902 65TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-3151
Practice Address - Country:US
Practice Address - Phone:262-995-4199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI219610163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse