Provider Demographics
NPI:1376161745
Name:SUSAN MINTER DNP APRN LLC
Entity Type:Organization
Organization Name:SUSAN MINTER DNP APRN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:571-214-6755
Mailing Address - Street 1:1234 RIDOUT RD
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:VA
Mailing Address - Zip Code:23950-2808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1234 RIDOUT RD
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:VA
Practice Address - Zip Code:23950-2808
Practice Address - Country:US
Practice Address - Phone:571-214-6755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-11
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care