Provider Demographics
NPI:1518483692
Name:MININGER, BETTY
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:MININGER
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 1:519 S 5TH ST STE 130
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944-1061
Mailing Address - Country:US
Mailing Address - Phone:215-257-8601
Mailing Address - Fax:
Practice Address - Street 1:1101 S BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-5393
Practice Address - Country:US
Practice Address - Phone:215-361-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017823363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health