Provider Demographics
NPI:1417674755
Name:MINTON, BETTY (RN)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:MINTON
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:PO BOX 136
Mailing Address - Street 2:
Mailing Address - City:UNITY
Mailing Address - State:WI
Mailing Address - Zip Code:54488-0136
Mailing Address - Country:US
Mailing Address - Phone:715-223-6435
Mailing Address - Fax:
Practice Address - Street 1:130 EAST 2ND STREET
Practice Address - Street 2:
Practice Address - City:UNITY
Practice Address - State:WI
Practice Address - Zip Code:54488-0136
Practice Address - Country:US
Practice Address - Phone:715-223-6435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI91700-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse