Provider Demographics
NPI:1962028803
Name:WINFIELD, WENDY CAROLINA
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:CAROLINA
Last Name:WINFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13941 FIRE CREEK TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7029
Mailing Address - Country:US
Mailing Address - Phone:253-886-9545
Mailing Address - Fax:
Practice Address - Street 1:13941 FIRE CREEK TRAIL DR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7029
Practice Address - Country:US
Practice Address - Phone:253-886-9545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCG6G7G4K7305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK7846597OtherMEDICAL BILLING