1104080779 NPI number — MS. ANDREA LOUISE WINKING RN BSN

Table of content: MS. ANDREA LOUISE WINKING RN BSN (NPI 1104080779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104080779 NPI number — MS. ANDREA LOUISE WINKING RN BSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINKING
Provider First Name:
ANDREA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN BSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MACKEY
Provider Other First Name:
ANDREA
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN BSN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104080779
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2323 WINDISH DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALESBURG
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-344-2323
Provider Business Mailing Address Fax Number:
309-344-4368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2323 WINDISH DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALESBURG
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-734-9461
Provider Business Practice Location Address Fax Number:
309-344-4368
Provider Enumeration Date:
07/14/2008

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: 163W00000X , with the licence number:  041322441 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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