Provider Demographics
NPI:1508467820
Name:WINTER, DENISE LESLIE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:LESLIE
Last Name:WINTER
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 1:296 WALL ST
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:NY
Mailing Address - Zip Code:13074-2120
Mailing Address - Country:US
Mailing Address - Phone:315-529-4772
Mailing Address - Fax:
Practice Address - Street 1:296 WALL ST
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:NY
Practice Address - Zip Code:13074-2120
Practice Address - Country:US
Practice Address - Phone:315-529-4772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376K00000X
NY809157163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide