Provider Demographics
NPI:1700271764
Name:WINSLOW, KATHERINE ELAINE (LAC, RAC, DIPL OM)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELAINE
Last Name:WINSLOW
Suffix:
Gender:F
Credentials:LAC, RAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2064 M 119
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9067
Mailing Address - Country:US
Mailing Address - Phone:231-373-8074
Mailing Address - Fax:
Practice Address - Street 1:2064 M 119
Practice Address - Street 2:SUITE 2
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9067
Practice Address - Country:US
Practice Address - Phone:231-373-8074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5401000153171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist