Provider Demographics
NPI:1972380970
Name:WINTERS, NICOLE XANDER (CSTSFA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:XANDER
Last Name:WINTERS
Suffix:
Gender:F
Credentials:CSTSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 DESERT PEACH CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-0850
Mailing Address - Country:US
Mailing Address - Phone:775-250-5858
Mailing Address - Fax:
Practice Address - Street 1:500 DAMONTE RANCH PKWY STE 958
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5911
Practice Address - Country:US
Practice Address - Phone:775-460-4626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV180664246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant