Provider Demographics
NPI:1417008384
Name:WINFIELD, THERESA SEWELL (ARNP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:SEWELL
Last Name:WINFIELD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:WINFIELD
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1123 POMONA RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-9353
Mailing Address - Country:US
Mailing Address - Phone:509-469-6823
Mailing Address - Fax:509-241-1841
Practice Address - Street 1:1123 POMONA RD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-9353
Practice Address - Country:US
Practice Address - Phone:509-469-6823
Practice Address - Fax:509-241-1841
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00045172163WP0809X
WAAP30004371363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA11629906OtherCAQH ID
WAAP30004371Medicare PIN
WAG8883001Medicare UPIN