Provider Demographics
NPI:1770927832
Name:WINCKLER, KAISA J (HBCE,CNMT)
Entity type:Individual
Prefix:MRS
First Name:KAISA
Middle Name:J
Last Name:WINCKLER
Suffix:
Gender:F
Credentials:HBCE,CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 TERRACE DR SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-5228
Mailing Address - Country:US
Mailing Address - Phone:320-979-3617
Mailing Address - Fax:
Practice Address - Street 1:228 TERRACE DR SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-5228
Practice Address - Country:US
Practice Address - Phone:320-979-3617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3030-08174H00000X
SD0221452471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology