Provider Demographics
NPI:1245312198
Name:WINTERS, SANDRA M (BSN MSN APN C)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:WINTERS
Suffix:
Gender:F
Credentials:BSN MSN APN C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 PAUL RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE SHADE
Mailing Address - State:NJ
Mailing Address - Zip Code:08052-3315
Mailing Address - Country:US
Mailing Address - Phone:856-663-4954
Mailing Address - Fax:
Practice Address - Street 1:1412 MARLTON PIKE E
Practice Address - Street 2:HCR MANORCARE
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2230
Practice Address - Country:US
Practice Address - Phone:856-428-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNO057015363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0051799Medicaid
Q30215Medicare UPIN
NJ0051799Medicaid