Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | KS | |
Y | 103T00000X | Psychologist | KS |
NPI | 1013103670 |
---|---|
Provider Name | Nicole Danielle Winterberg |
First Address | Lawrence, KS 66046-4463 |
Second Address | Lawrence, KS 66046-4463 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2007 |
Last Update Date | 08/07/2012 |