Provider Demographics
NPI:1205497443
Name:WINTERS, MARIA FERNANDA (ABOC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:FERNANDA
Last Name:WINTERS
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 ALPINE AVE NW STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-1631
Mailing Address - Country:US
Mailing Address - Phone:269-873-2505
Mailing Address - Fax:844-439-3392
Practice Address - Street 1:3233 ALPINE AVE NW STE A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-1631
Practice Address - Country:US
Practice Address - Phone:269-873-2505
Practice Address - Fax:844-439-3392
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI231108156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician