Provider Demographics
NPI:1205171667
Name:MINTON, ANGELA BETH (RN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:BETH
Last Name:MINTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4750
Mailing Address - Country:US
Mailing Address - Phone:937-648-8228
Mailing Address - Fax:
Practice Address - Street 1:162 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4750
Practice Address - Country:US
Practice Address - Phone:937-648-8228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1617592163W00000X
OHRN.273648163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse