Provider Demographics
NPI:1467021220
Name:WINKELMAN, SHANE
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:WINKELMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 HIGHWAY 95 NE
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-9589
Mailing Address - Country:US
Mailing Address - Phone:320-250-9913
Mailing Address - Fax:
Practice Address - Street 1:6200 HIGHWAY 95 NE
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-9589
Practice Address - Country:US
Practice Address - Phone:320-250-9913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care