Provider Demographics
NPI:1275877441
Name:MINKS, CORA TONY (LPN)
Entity Type:Individual
Prefix:MISS
First Name:CORA
Middle Name:TONY
Last Name:MINKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 PROSPECT AVE
Mailing Address - Street 2:#71
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-3978
Mailing Address - Country:US
Mailing Address - Phone:347-323-3710
Mailing Address - Fax:
Practice Address - Street 1:890 PROSPECT AVE
Practice Address - Street 2:#71
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3978
Practice Address - Country:US
Practice Address - Phone:347-323-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311569-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse