Provider Demographics
NPI:1659036119
Name:WINZENREAD, SAMANTHA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MARIE
Last Name:WINZENREAD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FIVE FORK PLAZA CT STE A
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-5460
Mailing Address - Country:US
Mailing Address - Phone:864-627-0444
Mailing Address - Fax:864-627-0555
Practice Address - Street 1:11 FIVE FORK PLAZA CT UNIT A
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-5460
Practice Address - Country:US
Practice Address - Phone:864-627-0444
Practice Address - Fax:864-627-0555
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMPA.4188363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant