Provider Demographics
NPI:1073544938
Name:WINTER, BEVERLY (NP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:WINTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 PENNOCK PL
Mailing Address - Street 2:STE 121
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3257
Mailing Address - Country:US
Mailing Address - Phone:970-221-3855
Mailing Address - Fax:970-212-1238
Practice Address - Street 1:1025 PENNOCK PL
Practice Address - Street 2:STE 121
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3257
Practice Address - Country:US
Practice Address - Phone:970-221-3855
Practice Address - Fax:970-212-1238
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO53938363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP70108Medicare UPIN
CO487598Medicare ID - Type Unspecified
CO500029967Medicare ID - Type UnspecifiedRAILROAD