Provider Demographics
NPI:1518684323
Name:MINNER, REBECCA ERIN (FNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ERIN
Last Name:MINNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ERIN
Other - Last Name:MINNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 N WINTER SUNRISE CIR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77375-1277
Mailing Address - Country:US
Mailing Address - Phone:858-248-7167
Mailing Address - Fax:
Practice Address - Street 1:107 N WINTER SUNRISE CIR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77375-1277
Practice Address - Country:US
Practice Address - Phone:858-248-7167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR219257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA