Provider Demographics
NPI:1740905496
Name:VANWINKLE, MARK W
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:VANWINKLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 VINEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1347
Mailing Address - Country:US
Mailing Address - Phone:330-388-0585
Mailing Address - Fax:
Practice Address - Street 1:470 VINEWOOD AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1347
Practice Address - Country:US
Practice Address - Phone:330-388-0585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion