Provider Demographics
NPI:1336607134
Name:MINIKUS, KATHRYN (APN)
Entity Type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:
Last Name:MINIKUS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4507
Mailing Address - Country:US
Mailing Address - Phone:908-642-3803
Mailing Address - Fax:
Practice Address - Street 1:200 HWY 31
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5812
Practice Address - Country:US
Practice Address - Phone:908-237-3405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00909500363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care