Provider Demographics
NPI:1205021466
Name:WINNICK, RIMMA FAINA (NPC)
Entity Type:Individual
Prefix:MRS
First Name:RIMMA
Middle Name:FAINA
Last Name:WINNICK
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-0151
Mailing Address - Country:US
Mailing Address - Phone:651-464-0267
Mailing Address - Fax:
Practice Address - Street 1:20555 INGERSOLL AVE N
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-9782
Practice Address - Country:US
Practice Address - Phone:651-464-0267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR137948-4363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500004198Medicare PIN