Provider Demographics
NPI:1497878292
Name:MINTER, VICTORIA W (DNP, CRNP)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:W
Last Name:MINTER
Suffix:
Gender:F
Credentials:DNP, CRNP
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 97
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-0097
Mailing Address - Country:US
Mailing Address - Phone:256-492-0131
Mailing Address - Fax:
Practice Address - Street 1:8225 AL HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:HORTON
Practice Address - State:AL
Practice Address - Zip Code:35980-8473
Practice Address - Country:US
Practice Address - Phone:256-593-3804
Practice Address - Fax:256-593-3805
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-052450363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL107894 (DOUGLAS)Medicaid
AL107895 (COMPLEX)Medicaid
AL515-95388OtherBLUE CROSS (DOUGLAS)
AL051509845MINMedicare ID - Type UnspecifiedMEDICARE
AL107894 (DOUGLAS)Medicaid
AL515-95388OtherBLUE CROSS (DOUGLAS)