Provider Demographics
NPI:1710286331
Name:MINIOR, EVAN SCOTT (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:SCOTT
Last Name:MINIOR
Suffix:
Gender:M
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-3321
Mailing Address - Country:US
Mailing Address - Phone:774-526-0931
Mailing Address - Fax:
Practice Address - Street 1:1672 S COUNTY TRL
Practice Address - Street 2:SUITE 302
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5098
Practice Address - Country:US
Practice Address - Phone:401-336-3770
Practice Address - Fax:401-336-3773
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37648363L00000X
MA2261011363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner