Basic Information
Provider Information
NPI: 1043844061
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WINTER
FirstName: ERIN
MiddleName: CATHLEEN
NamePrefix:  
NameSuffix:  
Credential: FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7388 PIKE RD
Address2:  
City: MONTVALE
State: VA
PostalCode: 241222975
CountryCode: US
TelephoneNumber: 5409817000
FaxNumber:  
Practice Location
Address1: 1906 BELLEVIEW AVE SE
Address2:  
City: ROANOKE
State: VA
PostalCode: 240141838
CountryCode: US
TelephoneNumber: 5405802963
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/28/2020
LastUpdateDate: 02/28/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/28/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X0024178084VAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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