Provider Demographics
NPI:1962760645
Name:WINTERS, TERESA KAY (SOLE MBR)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:KAY
Last Name:WINTERS
Suffix:
Gender:F
Credentials:SOLE MBR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30
Mailing Address - Street 2:12140 WILMINGTON AVENUE
Mailing Address - City:HIGHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:45132
Mailing Address - Country:US
Mailing Address - Phone:937-763-3843
Mailing Address - Fax:
Practice Address - Street 1:12140 WILMINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:OH
Practice Address - Zip Code:45132
Practice Address - Country:US
Practice Address - Phone:937-763-3843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH454327413374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide