Provider Demographics
NPI:1689963795
Name:MINTER, LONNET SHARON (STNA & PCT)
Entity Type:Individual
Prefix:
First Name:LONNET
Middle Name:SHARON
Last Name:MINTER
Suffix:
Gender:F
Credentials:STNA & PCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13100 SAINT JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-1637
Mailing Address - Country:US
Mailing Address - Phone:216-671-8641
Mailing Address - Fax:
Practice Address - Street 1:13100 SAINT JAMES AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-1637
Practice Address - Country:US
Practice Address - Phone:216-671-8641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400222980303376K00000X
GACN0028853224376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide