Provider Demographics
NPI:1144949793
Name:WINSTON, PATINA
Entity type:Individual
Prefix:
First Name:PATINA
Middle Name:
Last Name:WINSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5137 N PAWNEE TRL
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-7566
Mailing Address - Country:US
Mailing Address - Phone:219-214-6533
Mailing Address - Fax:
Practice Address - Street 1:5137 N PAWNEE TRL
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-7566
Practice Address - Country:US
Practice Address - Phone:219-214-6533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care