Provider Demographics
NPI:1205025848
Name:WINCHESTER, SUSAN H (APRN BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:H
Last Name:WINCHESTER
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 CENTRAL AVE
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8173
Mailing Address - Country:US
Mailing Address - Phone:308-234-6203
Mailing Address - Fax:308-234-3103
Practice Address - Street 1:3811 CENTRAL AVE
Practice Address - Street 2:SUITE B-1
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8173
Practice Address - Country:US
Practice Address - Phone:308-234-6203
Practice Address - Fax:308-234-3103
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110912363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health