Provider Demographics
NPI:1578099453
Name:MINCIN, KARL (BS)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:
Last Name:MINCIN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 W SECTION ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-4842
Mailing Address - Country:US
Mailing Address - Phone:360-336-2616
Mailing Address - Fax:
Practice Address - Street 1:313 W SECTION ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-4842
Practice Address - Country:US
Practice Address - Phone:360-336-2616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist