Provider Demographics
NPI:1407253958
Name:MINNICUCCI, KATHERINE (RN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MINNICUCCI
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 1:6222 HAMSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6455
Mailing Address - Country:US
Mailing Address - Phone:714-848-1744
Mailing Address - Fax:
Practice Address - Street 1:501 THE CITY DR S
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3305
Practice Address - Country:US
Practice Address - Phone:714-848-1744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-28
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA506465163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse