Provider Demographics
NPI:1023562402
Name:T R MINAFEE FAMILY NURSE PRACTITIONER LLC
Entity Type:Organization
Organization Name:T R MINAFEE FAMILY NURSE PRACTITIONER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINAFEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-803-7824
Mailing Address - Street 1:4516 W MAGDALENA LN
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2350
Mailing Address - Country:US
Mailing Address - Phone:414-803-7824
Mailing Address - Fax:
Practice Address - Street 1:4516 W MAGDALENA LN
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2350
Practice Address - Country:US
Practice Address - Phone:414-803-7824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty