Basic Information
| Provider Information | |||||||||
| NPI: | 1194895888 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEARHOLT-WINCKLER | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | RN, WHCNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30521 HARRIS TOWN RD | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557444776 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1601 GOLF COURSE RD | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557448648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2189991442 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 02/23/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | R124952-7 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | HP26447 | 01 | HEALTH PARTNERS PROV ID | OTHER | 666420200 | 05 | MN | MEDICAID | 07-00637 | 01 | MEDICA PROVIDER ID | OTHER | 122972 | 01 | UCARE PROVIDER ID | OTHER | 1016947 | 01 | PREFERRED ONE PROV ID | OTHER | 68G08DE | 01 | BCBS MN PROVIDER ID | OTHER | MD1203215 | 01 | MN | DEA | OTHER | 1068173 | 01 | AMERICA'S PPO PROV ID | OTHER | 29076 | 01 | SIOUX VALLEY PROV ID | OTHER |