Provider Demographics
NPI:1629202114
Name:WINTER, LISA CATHLEEN (ANP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CATHLEEN
Last Name:WINTER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-1291
Mailing Address - Fax:314-454-5211
Practice Address - Street 1:5201 MID AMERICA PLZ
Practice Address - Street 2:DIV IM CARDIOLOGY, STE 2300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-0002
Practice Address - Country:US
Practice Address - Phone:314-362-1291
Practice Address - Fax:314-454-5211
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010017627363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424583409Medicaid