Provider Demographics
NPI:1255326955
Name:WINSTON, MARY C (NP,RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:C
Last Name:WINSTON
Suffix:
Gender:F
Credentials:NP,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-2455
Mailing Address - Country:US
Mailing Address - Phone:540-463-2181
Mailing Address - Fax:540-463-1125
Practice Address - Street 1:108 HOUSTON ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2455
Practice Address - Country:US
Practice Address - Phone:540-463-2181
Practice Address - Fax:540-463-1125
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024065991207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC00827OtherMEDICARE
VA144874OtherSOUTHERN HEALTH SERVICES
VAB4313OtherRAILROAD MEDICARE
VA500000003Medicare PIN
VA144874OtherSOUTHERN HEALTH SERVICES