Provider Demographics
NPI:1518461490
Name:MINCHILLO, DEANA
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:
Last Name:MINCHILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3928 CHURCHILL DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1522
Mailing Address - Country:US
Mailing Address - Phone:469-867-6950
Mailing Address - Fax:
Practice Address - Street 1:3928 CHURCHILL DR
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1522
Practice Address - Country:US
Practice Address - Phone:469-867-6950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302624164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse