Provider Demographics
NPI:1861012353
Name:MINNICK, KATHY ANN (RN)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:MINNICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17756 BARRENS RD N
Mailing Address - Street 2:
Mailing Address - City:STEWARTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17363-7742
Mailing Address - Country:US
Mailing Address - Phone:443-527-3223
Mailing Address - Fax:
Practice Address - Street 1:17756 BARRENS RD N
Practice Address - Street 2:
Practice Address - City:STEWARTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17363-7742
Practice Address - Country:US
Practice Address - Phone:443-527-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN698979163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health