Provider Demographics
NPI:1205382025
Name:CHANNEL, MINNIE LUCILLE (RN)
Entity Type:Individual
Prefix:MS
First Name:MINNIE
Middle Name:LUCILLE
Last Name:CHANNEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-4110
Mailing Address - Country:US
Mailing Address - Phone:740-644-2363
Mailing Address - Fax:
Practice Address - Street 1:143 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-4110
Practice Address - Country:US
Practice Address - Phone:740-644-2363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN253290163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health