Provider Demographics
NPI:1992756472
Name:WINANS, NINA SKATTUM (MD)
Entity type:Individual
Prefix:DR
First Name:NINA
Middle Name:SKATTUM
Last Name:WINANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14824 ALDER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-6873
Mailing Address - Country:US
Mailing Address - Phone:530-582-5762
Mailing Address - Fax:
Practice Address - Street 1:10710 DONNER PASS RD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4812
Practice Address - Country:US
Practice Address - Phone:530-582-7488
Practice Address - Fax:530-582-7489
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAG71759207QS0010X
CAG71759207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF66544Medicare UPIN
CAYYY20569YMedicare ID - Type UnspecifiedOLD GROUP NUMBER