Provider Demographics
NPI:1407038078
Name:WINTER, JENNIFER LEIGH (RD,LD)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LEIGH
Last Name:WINTER
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 N HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4913
Mailing Address - Country:US
Mailing Address - Phone:316-685-1381
Mailing Address - Fax:
Practice Address - Street 1:855 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4913
Practice Address - Country:US
Practice Address - Phone:316-685-1381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS385133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0399360001OtherMEDI NSC