Individual
MARY F WINEGARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
507 MAIN AVE, CLEAR LAKE, IA 50428-1828
(641) 357-4325
(641) 357-1295
Mailing address
507 MAIN AVE, PO BOX 506, CLEAR LAKE, IA 50428-1828
(641) 357-4325
(641) 357-1295
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
722
IA
363A00000X
Physician Assistant
9964
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
173478400
—
MN
Enumeration date
01/19/2006
Last updated
11/07/2013
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