Provider Demographics
NPI:1295534121
Name:WINSTON, MIKKA
Entity type:Individual
Prefix:
First Name:MIKKA
Middle Name:
Last Name:WINSTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MIKKA
Other - Middle Name:
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3436 PORTIA ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-1775
Mailing Address - Country:US
Mailing Address - Phone:402-202-3774
Mailing Address - Fax:
Practice Address - Street 1:390 N COTNER BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2371
Practice Address - Country:US
Practice Address - Phone:402-287-6171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant