1790883460 NPI number — CARRIE L VANWINKLE DC

Table of content: CARRIE L VANWINKLE DC (NPI 1790883460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790883460 NPI number — CARRIE L VANWINKLE DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANWINKLE
Provider First Name:
CARRIE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STRYCKER
Provider Other First Name:
CARRIE
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790883460
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
132 N EMERY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PESHTIGO
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54157-1214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-582-4098
Provider Business Mailing Address Fax Number:
715-582-4097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
132 N EMERY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PESHTIGO
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54157-1214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-582-4098
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3893-012 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CB3715 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 145186845 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 38945300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 350057077 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 38998100 . This is a "MEDICAID GROUP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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