Provider Demographics
NPI:1811542517
Name:MCMINN, MELVA
Entity Type:Individual
Prefix:
First Name:MELVA
Middle Name:
Last Name:MCMINN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 BLUEBONNET LN
Mailing Address - Street 2:
Mailing Address - City:ADKINS
Mailing Address - State:TX
Mailing Address - Zip Code:78101-2708
Mailing Address - Country:US
Mailing Address - Phone:830-947-3109
Mailing Address - Fax:
Practice Address - Street 1:1004 BLUEBONNET LN
Practice Address - Street 2:
Practice Address - City:ADKINS
Practice Address - State:TX
Practice Address - Zip Code:78101-2708
Practice Address - Country:US
Practice Address - Phone:830-947-3109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider