Provider Demographics
NPI:1003596578
Name:WINSOR, LAUREL CASIMIRA
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:CASIMIRA
Last Name:WINSOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15616 45TH ST S
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:MN
Mailing Address - Zip Code:55001-9684
Mailing Address - Country:US
Mailing Address - Phone:612-382-8733
Mailing Address - Fax:
Practice Address - Street 1:336 HUNTINGTON AVE
Practice Address - Street 2:ROBINSON HALL 202
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-373-3195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program