Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 1068143 | AL |
NPI | 1023029659 |
---|---|
Provider Name | Mary Ann Winokur |
First Address | Birmingham, AL 35255-5310 |
Second Address | Birmingham, AL 35233 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 17/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000079581 | (05) | AL |
051079581 | BCBS (01) | AL |
051510729 | BCBS (01) | AL |
500026920 | RR MEDICARE (01) | AL |
891004760 | (05) | AL |
P67308 | (02) | AL |