Provider Demographics
NPI:1811630635
Name:WINTER, IAN PATRICK (RDN)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:PATRICK
Last Name:WINTER
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 KINGS WAY DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5535
Mailing Address - Country:US
Mailing Address - Phone:757-605-8181
Mailing Address - Fax:
Practice Address - Street 1:115 COLLEGE PL STE A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1930
Practice Address - Country:US
Practice Address - Phone:757-605-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86292737133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered