Provider Demographics
NPI:1013080340
Name:LASSITER, WINIFRED CECELIA (MD)
Entity type:Individual
Prefix:
First Name:WINIFRED
Middle Name:CECELIA
Last Name:LASSITER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:WINIFRED
Other - Middle Name:CECELIA
Other - Last Name:RUTTLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:301 W END AVE
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-1725
Mailing Address - Country:US
Mailing Address - Phone:615-446-2839
Mailing Address - Fax:
Practice Address - Street 1:301 W END AVE
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1725
Practice Address - Country:US
Practice Address - Phone:615-446-2839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21504207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F4606Medicare UPIN