1841675022 NPI number — PAULETTE LAVINIA WINKFIELD CADC, CCDP

Table of content: PAULETTE LAVINIA WINKFIELD CADC, CCDP (NPI 1841675022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841675022 NPI number — PAULETTE LAVINIA WINKFIELD CADC, CCDP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINKFIELD
Provider First Name:
PAULETTE
Provider Middle Name:
LAVINIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CADC, CCDP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CANNON
Provider Other First Name:
PAULETTE
Provider Other Middle Name:
LAVINIA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841675022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1241 COLLEGE PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19904-8713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-735-7790
Provider Business Mailing Address Fax Number:
302-735-3652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1241 COLLEGE PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19904-8713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-735-7790
Provider Business Practice Location Address Fax Number:
302-735-3652
Provider Enumeration Date:
07/29/2015

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: 101YA0400X , with the licence number:  1483 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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