Provider Demographics
NPI:1699439968
Name:WINNING, STACI RENE (NP-C)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:RENE
Last Name:WINNING
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4567 CAROLINE GRACE LN
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-8274
Mailing Address - Country:US
Mailing Address - Phone:812-230-4441
Mailing Address - Fax:
Practice Address - Street 1:4567 CAROLINE GRACE LN
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-8274
Practice Address - Country:US
Practice Address - Phone:812-230-4441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF09211386363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner