Provider Demographics
NPI:1013479914
Name:HOWARD, MINDY SUE
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:SUE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26717 ROSS POINT RD
Mailing Address - Street 2:
Mailing Address - City:NISSWA
Mailing Address - State:MN
Mailing Address - Zip Code:56468-2420
Mailing Address - Country:US
Mailing Address - Phone:520-729-6138
Mailing Address - Fax:
Practice Address - Street 1:4451 E WOODMAN ST
Practice Address - Street 2:
Practice Address - City:PEQUOT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56472-2894
Practice Address - Country:US
Practice Address - Phone:218-568-5605
Practice Address - Fax:218-568-4272
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide