Provider Demographics
NPI:1417557075
Name:WYNSTRA, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:WYNSTRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 19TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-5031
Mailing Address - Country:US
Mailing Address - Phone:701-400-8621
Mailing Address - Fax:
Practice Address - Street 1:1702 3RD AVE NW APT 4
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-1843
Practice Address - Country:US
Practice Address - Phone:701-425-9314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker