Provider Demographics
NPI:1922233576
Name:MINCY, ELIZABETH PATRICIA (APRN-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PATRICIA
Last Name:MINCY
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 MADISON AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-4641
Mailing Address - Country:US
Mailing Address - Phone:618-451-1500
Mailing Address - Fax:618-451-9484
Practice Address - Street 1:2044 MADISON AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-4641
Practice Address - Country:US
Practice Address - Phone:618-451-1500
Practice Address - Fax:618-451-9484
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209007561363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health