Provider Demographics
NPI:1326514225
Name:MINNICH, STEPHANIE ILENE (CBC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ILENE
Last Name:MINNICH
Suffix:
Gender:F
Credentials:CBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 AVENUE I
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3033
Mailing Address - Country:US
Mailing Address - Phone:301-440-5663
Mailing Address - Fax:
Practice Address - Street 1:3016 AVENUE I
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3033
Practice Address - Country:US
Practice Address - Phone:301-440-5663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN