Provider Demographics
NPI:1346212586
Name:WINTER, MARY E (CRNA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:WINTER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3705 N 139TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-4234
Mailing Address - Country:US
Mailing Address - Phone:913-721-3641
Mailing Address - Fax:913-721-3649
Practice Address - Street 1:4510 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3238
Practice Address - Country:US
Practice Address - Phone:816-364-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105850367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100249390FMedicaid
KS145390OtherBLUE CROSS BLUE SHIELD KANSAS
5759611OtherFIRST HEALTH
MOP00365463OtherRAILROAD MEDICARE
MO22069048OtherBLUE CROSS BLUE SHIELD KANSAS CITY
KSP00410954OtherRAILROAD MEDICARE
66048A016OtherTRICARE WPS
MO912669439Medicaid
MO10001883400OtherCOMMUNITY HEALTH PLAN
MO10001883400OtherCOMMUNITY HEALTH PLAN
KSP00410954OtherRAILROAD MEDICARE
KSW490817BMedicare PIN
5759611OtherFIRST HEALTH