Provider Demographics
NPI:1083197206
Name:WINN, SANDRA DENISE (CFM)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:DENISE
Last Name:WINN
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64594 N 2514 ROAD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OK
Mailing Address - Zip Code:73724
Mailing Address - Country:US
Mailing Address - Phone:512-852-6376
Mailing Address - Fax:
Practice Address - Street 1:64594 N 2514 ROAD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OK
Practice Address - Zip Code:73724
Practice Address - Country:US
Practice Address - Phone:512-852-6376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter