Provider Demographics
NPI:1487624979
Name:WINTERS, KRISTEN E (DPM)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:E
Last Name:WINTERS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1379 ENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-5524
Mailing Address - Country:US
Mailing Address - Phone:860-741-3041
Mailing Address - Fax:860-741-5644
Practice Address - Street 1:1379 ENFIELD ST
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-5524
Practice Address - Country:US
Practice Address - Phone:860-741-3041
Practice Address - Fax:860-741-5644
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000731213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
2V1420OtherHEALTHNET
480034429OtherMEDICARE RAILROAD
P2480115OtherOXFORD
061159308OtherTRICARE
4352239-002OtherCIGNA
0007311330OtherCONNECTICARE
030000731CT04OtherANTHEM
2930502OtherAETNA