Provider Demographics
NPI:1457090656
Name:WINIARSKI, PAULA MAE (MSN)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:MAE
Last Name:WINIARSKI
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:MAE
Other - Last Name:KUIPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-955-7040
Mailing Address - Fax:414-955-0175
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-955-7040
Practice Address - Fax:414-955-0175
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13089363L00000X
WI246225-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1457090656Medicaid