Provider Demographics
NPI:1912909722
Name:WINES, MARIA (PNP)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:WINES
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 W MAIN
Mailing Address - Street 2:SOUTH VALLEY PEDIATRICS
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840
Mailing Address - Country:US
Mailing Address - Phone:406-363-5013
Mailing Address - Fax:406-363-3714
Practice Address - Street 1:1114 W MAIN
Practice Address - Street 2:SOUTH VALLEY PEDIATRICS
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840
Practice Address - Country:US
Practice Address - Phone:406-363-5013
Practice Address - Fax:406-363-3714
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN25738363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTRN 25738OtherNOT SPECIFIED
373490OtherBCBS
MT4306168Medicaid