Provider Demographics
NPI:1770066748
Name:WINSLOW, PETER JOHN
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:JOHN
Last Name:WINSLOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 W CLAY ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4716
Mailing Address - Country:US
Mailing Address - Phone:707-462-6290
Mailing Address - Fax:707-468-6427
Practice Address - Street 1:201 BRUSH ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-3424
Practice Address - Country:US
Practice Address - Phone:707-462-6290
Practice Address - Fax:707-468-6427
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker