Provider Demographics
NPI:1659154649
Name:MINIOR, NICHOLAS MICHAEL (FNP)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:MICHAEL
Last Name:MINIOR
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 CHACE AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2937
Mailing Address - Country:US
Mailing Address - Phone:843-467-8265
Mailing Address - Fax:
Practice Address - Street 1:1830 MINERAL SPRING AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-3864
Practice Address - Country:US
Practice Address - Phone:401-351-1900
Practice Address - Fax:401-270-0380
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN03632363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily