Doctor Name: | WINOKULI BERTRAND |
NPI Number: | 1104215219 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 2259942 |
Business Practice Address: | 14 Wheeler Cir Apt 13 Stoughton, MA - 020721371 |
Business Phone Number: | 7815529499 |
Business Fax Number: | |
Mailing Address: | 14 Wheeler Cir, Apt 13 STOUGHTON |
State: | MA |
Postal Code: | 020721371 |
Phone Number: | 7815529499 |
Fax Number: | |
NPI Enumeration Date: | 01/13/2015 |
NPI Last Update Date: | 01/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 2259942 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |