Provider Demographics
NPI:1013376862
Name:WASHINGTON, MINNIE
Entity Type:Individual
Prefix:
First Name:MINNIE
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 FIFE DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-4138
Mailing Address - Country:US
Mailing Address - Phone:936-703-3100
Mailing Address - Fax:
Practice Address - Street 1:926 FIFE DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-4138
Practice Address - Country:US
Practice Address - Phone:936-703-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX688799163W00000X, 163WH0200X, 163WH1000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No374U00000XNursing Service Related ProvidersHome Health Aide