Provider Demographics
NPI:1578934410
Name:MINTON, TWOLLA KAY (LPN)
Entity Type:Individual
Prefix:
First Name:TWOLLA
Middle Name:KAY
Last Name:MINTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-1360
Mailing Address - Country:US
Mailing Address - Phone:937-205-8357
Mailing Address - Fax:
Practice Address - Street 1:462 S ELM ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-1360
Practice Address - Country:US
Practice Address - Phone:937-205-8357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.152402-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse