Provider Demographics
NPI:1528235488
Name:WINICK, ANDREA (RN, CNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:WINICK
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 24TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3026
Mailing Address - Country:US
Mailing Address - Phone:612-724-0326
Mailing Address - Fax:
Practice Address - Street 1:12755 HIGHWAY 55
Practice Address - Street 2:MN009-S130
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-3837
Practice Address - Country:US
Practice Address - Phone:800-896-8936
Practice Address - Fax:888-866-3209
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0483232364SA2200X, 364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN812517100Medicaid
MNS45107Medicare UPIN