Provider Demographics
NPI:1700906633
Name:WINONA STATE UNIVERSITY STUDENT HEALTH SERVICES
Entity Type:Organization
Organization Name:WINONA STATE UNIVERSITY STUDENT HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF STUDENT HEALTH SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:PALM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CNP
Authorized Official - Phone:507-457-5160
Mailing Address - Street 1:175 W MARK ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3384
Mailing Address - Country:US
Mailing Address - Phone:507-457-5160
Mailing Address - Fax:507-457-2326
Practice Address - Street 1:175 W MARK ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3384
Practice Address - Country:US
Practice Address - Phone:507-457-5160
Practice Address - Fax:507-457-2326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health