Individual
MR. TIMOTHY ERIC VANWINKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1747 IMPERIAL BLVD, LAKE CHARLES, LA 70605-5362
(337) 721-7236
(337) 721-7237
Mailing address
1747 IMPERIAL BLVD, LAKE CHARLES, LA 70605-5362
Taxonomy
Speciality
Code
Description
License number
State
163WX0800X
Orthopedic Registered Nurse
RN84018
LA
363LF0000X
Family Nurse Practitioner
Primary
221156
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
221156
MEDICAL LICENSE
LA
01
—
RN84018
STATE LICENSE #
LA
Enumeration date
08/09/2006
Last updated
08/12/2021
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