Provider Demographics
NPI:1366623290
Name:WINTER, MA'AYAN D (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MA'AYAN
Middle Name:D
Last Name:WINTER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:M
Other - Last Name:WINTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1215 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6727
Mailing Address - Country:US
Mailing Address - Phone:575-415-4768
Mailing Address - Fax:
Practice Address - Street 1:1215 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6727
Practice Address - Country:US
Practice Address - Phone:575-415-4768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02769363LP0808X
MARN2259895363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty