Provider Demographics
NPI:1356526289
Name:WINES, CONNIE ELAINE (BS, ADN)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:ELAINE
Last Name:WINES
Suffix:
Gender:F
Credentials:BS, ADN
Other - Prefix:MISS
Other - First Name:CONNIE
Other - Middle Name:ELAINE
Other - Last Name:BURLESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 E NORTH UNION ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-3779
Mailing Address - Country:US
Mailing Address - Phone:989-894-2060
Mailing Address - Fax:
Practice Address - Street 1:900 E NORTH UNION ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-3779
Practice Address - Country:US
Practice Address - Phone:989-894-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704169941163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse