Basic Information
Provider Information
NPI: 1063444552
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WINETT
FirstName: EMILY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2500 W UTOPIA RD
Address2: STE. 100
City: PHOENIX
State: AZ
PostalCode: 850274171
CountryCode: US
TelephoneNumber: 6022146148
FaxNumber: 6022146149
Practice Location
Address1: 3648 W ANTHEM WAY
Address2: BLDG A100
City: ANTHEM
State: AZ
PostalCode: 850867001
CountryCode: US
TelephoneNumber: 6234346444
FaxNumber: 6234346448
Other Information
ProviderEnumerationDate: 07/07/2006
LastUpdateDate: 09/24/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X34995AZY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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