Provider Demographics
NPI:1619164589
Name:WINKELJOHN, DEBRA LYNN (CNS)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:LYNN
Last Name:WINKELJOHN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:715 DR MARTIN LUTHER KING JR AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3661
Mailing Address - Country:US
Mailing Address - Phone:505-727-3040
Mailing Address - Fax:505-727-3099
Practice Address - Street 1:4901 LANG AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4495
Practice Address - Country:US
Practice Address - Phone:505-842-8171
Practice Address - Fax:505-246-0684
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNS00101364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM59509074Medicaid