Provider Demographics
NPI:1891841664
Name:MINTCH, CYNTHIA SUE (WHNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SUE
Last Name:MINTCH
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6812
Mailing Address - Country:US
Mailing Address - Phone:260-423-1322
Mailing Address - Fax:260-423-2692
Practice Address - Street 1:3914 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6812
Practice Address - Country:US
Practice Address - Phone:260-423-1322
Practice Address - Fax:260-423-2692
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28094852A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health