Provider Demographics
NPI:1497063366
Name:WINGET, BARBIE DIANE (SHAD)
Entity Type:Individual
Prefix:MRS
First Name:BARBIE
Middle Name:DIANE
Last Name:WINGET
Suffix:
Gender:F
Credentials:SHAD
Other - Prefix:MR
Other - First Name:SCOTT
Other - Middle Name:A
Other - Last Name:WINGET
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HAD
Mailing Address - Street 1:8219 WICKER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-8878
Mailing Address - Country:US
Mailing Address - Phone:219-558-0454
Mailing Address - Fax:219-558-0645
Practice Address - Street 1:8219 WICKER AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-8878
Practice Address - Country:US
Practice Address - Phone:219-558-0454
Practice Address - Fax:219-558-0645
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001135A171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor