Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251C2600X | Cardiopulmonary | 16-00278 | KS |
NPI | 1255367249 |
---|---|
Provider Name | Ms. Theresa Gayle Winter |
First Address | Larned, KS 67550-3045 |
Second Address | Larned, KS 67550-3045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 20/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000048194 | BLUE CROSS/BLUE SHIELD NO (01) | KS |
100444200B | (05) | KS |