Provider Demographics
NPI:1922004068
Name:MINCHHOFF, DOLORES ANNE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:DOLORES
Middle Name:ANNE
Last Name:MINCHHOFF
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 MARTIC HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:HOLTWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:17532-9679
Mailing Address - Country:US
Mailing Address - Phone:717-284-2065
Mailing Address - Fax:
Practice Address - Street 1:620 SPEAR ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:PA
Practice Address - Zip Code:19363-1655
Practice Address - Country:US
Practice Address - Phone:610-932-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP005714B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAVP005714BOtherLICENSE NUMBER
PA028596GKGMedicare ID - Type Unspecified
PAS84025Medicare UPIN