Provider Demographics
NPI:1316306277
Name:WINCE, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:WINCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:GARDINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:47665 MARGARET BRENT WAY
Mailing Address - Street 2:
Mailing Address - City:ST MARY'S CITY
Mailing Address - State:MD
Mailing Address - Zip Code:20630
Mailing Address - Country:US
Mailing Address - Phone:240-895-4289
Mailing Address - Fax:240-895-4937
Practice Address - Street 1:47665 MARGARET BRENT WAY
Practice Address - Street 2:
Practice Address - City:ST MARY'S CITY
Practice Address - State:MD
Practice Address - Zip Code:20630
Practice Address - Country:US
Practice Address - Phone:240-895-4289
Practice Address - Fax:240-895-4937
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR195682363LS0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD481844ZDN3Medicare PIN