Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 0101260759 | VA |
NPI | 1043606080 |
---|---|
Provider Name | Jessica R Winters |
First Address | Portsmouth, VA 23708-2111 |
Second Address | Portsmouth, VA 23708-2111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2015 |
Last Update Date | 15/06/2021 |