Provider Demographics
NPI:1053387811
Name:STOLTZFUS, WINONA (MD)
Entity type:Individual
Prefix:
First Name:WINONA
Middle Name:
Last Name:STOLTZFUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SAN MATEO BLVD NE STE 902
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1507
Mailing Address - Country:US
Mailing Address - Phone:505-222-8684
Mailing Address - Fax:505-222-8675
Practice Address - Street 1:300 SAN MATEO BLVD NE STE 902
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1507
Practice Address - Country:US
Practice Address - Phone:505-222-8684
Practice Address - Fax:505-222-8675
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001-110208000000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMF2345Medicaid
NMF2345Medicaid
NMH38719Medicare ID - Type Unspecified