Provider Demographics
NPI:1639816085
Name:WINCHESTER, ELLEN C (175T00000X)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:C
Last Name:WINCHESTER
Suffix:
Gender:F
Credentials:175T00000X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 CENTENNIAL PLZ
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2474
Mailing Address - Country:US
Mailing Address - Phone:541-345-9369
Mailing Address - Fax:
Practice Address - Street 1:2145 CENTENNIAL PLZ
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2474
Practice Address - Country:US
Practice Address - Phone:541-345-9369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000002695175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist