Provider Demographics
NPI:1538667571
Name:WINTERS, ANISSA
Entity Type:Individual
Prefix:
First Name:ANISSA
Middle Name:
Last Name:WINTERS
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 1:1111 MCDONALD ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-1732
Mailing Address - Country:US
Mailing Address - Phone:419-984-4053
Mailing Address - Fax:
Practice Address - Street 1:1111 MCDONALD ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-1732
Practice Address - Country:US
Practice Address - Phone:419-984-4053
Practice Address - Fax:419-984-4053
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH484429830902Medicaid