Provider Demographics
NPI:1407678568
Name:WINJUM, HAYDEN PAULETTE
Entity type:Individual
Prefix:
First Name:HAYDEN
Middle Name:PAULETTE
Last Name:WINJUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2951 24TH AVE S APT 116
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6159
Mailing Address - Country:US
Mailing Address - Phone:218-289-4323
Mailing Address - Fax:
Practice Address - Street 1:724 STUART AVE
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-1665
Practice Address - Country:US
Practice Address - Phone:218-289-4323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10859111310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility