Provider Demographics
NPI:1972957835
Name:NORDNESS, MINA FAYE (MD, MPH)
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:FAYE
Last Name:NORDNESS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VANDERBILT UNIVERSITY MEDICAL CENTER 1161 AVE S
Mailing Address - Street 2:CCC-4312 MCN
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-2730
Mailing Address - Country:US
Mailing Address - Phone:615-343-6642
Mailing Address - Fax:615-322-0689
Practice Address - Street 1:VANDERBILT UNIVERSITY MEDICAL CENTER 1161 AVE S
Practice Address - Street 2:CCC-4312 MCN
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-2730
Practice Address - Country:US
Practice Address - Phone:615-343-6642
Practice Address - Fax:615-322-0689
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN58837208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program