Provider Demographics
NPI:1053828756
Name:WINBUSH, TANYA TROTTER (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:TROTTER
Last Name:WINBUSH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BROOKSTONE LN
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-5874
Mailing Address - Country:US
Mailing Address - Phone:336-598-1054
Mailing Address - Fax:
Practice Address - Street 1:20 COURT ST
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-5202
Practice Address - Country:US
Practice Address - Phone:336-598-1054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC262617163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty