Provider Demographics
NPI:1508688029
Name:MINOR, ANTIONETTE S (PSA)
Entity type:Individual
Prefix:
First Name:ANTIONETTE
Middle Name:S
Last Name:MINOR
Suffix:
Gender:F
Credentials:PSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BELMAR AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-5219
Mailing Address - Country:US
Mailing Address - Phone:317-445-3707
Mailing Address - Fax:
Practice Address - Street 1:107 BELMAR AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-5219
Practice Address - Country:US
Practice Address - Phone:317-445-3707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide