Provider Demographics
NPI:1831326313
Name:WINCHESTER, ELISA V (LPN)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:V
Last Name:WINCHESTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 W SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-5400
Mailing Address - Country:US
Mailing Address - Phone:907-864-0354
Mailing Address - Fax:907-864-0364
Practice Address - Street 1:174 W SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-5400
Practice Address - Country:US
Practice Address - Phone:907-864-0354
Practice Address - Fax:907-864-0364
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK989394310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility