Provider Demographics
NPI:1912357401
Name:VILLA MINCH, LLC
Entity Type:Organization
Organization Name:VILLA MINCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINCH
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:480-543-8400
Mailing Address - Street 1:1212 N SPENCER
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-4347
Mailing Address - Country:US
Mailing Address - Phone:480-726-7792
Mailing Address - Fax:
Practice Address - Street 1:1212 N SPENCER
Practice Address - Street 2:SUITE 3
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-4347
Practice Address - Country:US
Practice Address - Phone:480-726-7792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty