Provider Demographics
NPI:1760666432
Name:WINTERS, AMANDA S (CNM)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:S
Last Name:WINTERS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:574-237-6069
Practice Address - Street 1:1215 LAWN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2450
Practice Address - Country:US
Practice Address - Phone:574-293-2893
Practice Address - Fax:574-293-1298
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN72000130A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200884120Medicaid
IN000000851358OtherBCBS BMG OBGYN
IN000000548222OtherANTHEM BCBS #
IN000000851358OtherBCBS BMG OBGYN
IN250820CMedicare PIN
INP00864350 RR MEDICAMedicare PIN