Provider Demographics
NPI:1235641499
Name:WINTERS, ROBERT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:WINTERS
Suffix:
Gender:M
Credentials:
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 738
Mailing Address - Street 2:
Mailing Address - City:PANACA
Mailing Address - State:NV
Mailing Address - Zip Code:89042-0738
Mailing Address - Country:US
Mailing Address - Phone:775-962-8089
Mailing Address - Fax:
Practice Address - Street 1:1005 MAIN ST
Practice Address - Street 2:
Practice Address - City:PANACA
Practice Address - State:NV
Practice Address - Zip Code:89042
Practice Address - Country:US
Practice Address - Phone:775-962-8089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician