Provider Demographics
NPI:1043386485
Name:WINT, MILDRED ROSE (RD)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:ROSE
Last Name:WINT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MILDRED
Other - Middle Name:ROSE
Other - Last Name:STEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:ATTN NUTRITIONAL SERVICES
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-2187
Mailing Address - Fax:810-342-3696
Practice Address - Street 1:401 S BALLENGER HWY
Practice Address - Street 2:ATTN NUTRITIONAL SERVICES
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3638
Practice Address - Country:US
Practice Address - Phone:810-342-2187
Practice Address - Fax:810-342-3696
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL354208133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered