Provider Demographics
NPI:1174613475
Name:WINTERS, SANDRA LEE (CRNP)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LEE
Last Name:WINTERS
Suffix:
Gender:F
Credentials:CRNP
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Mailing Address - Street 1:15 PUBLIC SQ
Mailing Address - Street 2:SUITE 600
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-1702
Mailing Address - Country:US
Mailing Address - Phone:570-826-1777
Mailing Address - Fax:570-823-3040
Practice Address - Street 1:640 MADISON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1631
Practice Address - Country:US
Practice Address - Phone:570-961-5550
Practice Address - Fax:570-961-3844
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2016-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PASP007929363LF0000X
NJ26NJ00055800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007678420039Medicaid
PA1025995680003Medicaid
PA1025995680004Medicaid
PA1007678420043Medicaid
PA1007678420039Medicaid
PA1007678420039Medicaid
PA1007678420043Medicaid