Provider Demographics
NPI:1558687459
Name:MINNICK, NATHANIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:
Last Name:MINNICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 J CLYDE MORRIS BLVD
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1929
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 J CLYDE MORRIS BLVD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1929
Practice Address - Country:US
Practice Address - Phone:757-594-2083
Practice Address - Fax:757-594-2196
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102203770207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine