Provider Demographics
NPI:1114696028
Name:WINNELL, ASIAH R
Entity Type:Individual
Prefix:
First Name:ASIAH
Middle Name:R
Last Name:WINNELL
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 1:3918 FISHER ROAD
Mailing Address - Street 2:
Mailing Address - City:KENNA
Mailing Address - State:WV
Mailing Address - Zip Code:25248
Mailing Address - Country:US
Mailing Address - Phone:304-514-8803
Mailing Address - Fax:
Practice Address - Street 1:3918 FISHER ROAD
Practice Address - Street 2:
Practice Address - City:KENNA
Practice Address - State:WV
Practice Address - Zip Code:25248
Practice Address - Country:US
Practice Address - Phone:304-514-8803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant