Provider Demographics
NPI:1598059941
Name:WINTER, KERWIN H (LPN)
Entity Type:Individual
Prefix:
First Name:KERWIN
Middle Name:H
Last Name:WINTER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1718
Mailing Address - Country:US
Mailing Address - Phone:347-586-6981
Mailing Address - Fax:
Practice Address - Street 1:154 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-1718
Practice Address - Country:US
Practice Address - Phone:347-586-6981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300893-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse