Individual
CANDACE M WINTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2201 S DOUGLAS HWY STE 120, GILLETTE, WY 82718-5408
(800) 446-9556
Mailing address
PO BOX 6850, RAPID CITY, SD 57709-6850
(605) 341-1414
(605) 341-7062
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0645
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0645
LICENSE
SD
05
—
1477523678
—
SD
01
—
4993240
WELLMARK
SD
05
—
6829360
—
SD
01
—
9248507
DAKOTACARE
SD
Enumeration date
04/05/2007
Last updated
01/22/2019
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