Provider Demographics
NPI:1831973098
Name:MINTER, MELISSA JEAN (FNP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEAN
Last Name:MINTER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JEAN
Other - Last Name:BURLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 ATWELL RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1301
Mailing Address - Country:US
Mailing Address - Phone:607-547-3456
Mailing Address - Fax:
Practice Address - Street 1:321 E ALBANY ST
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-2016
Practice Address - Country:US
Practice Address - Phone:315-867-2700
Practice Address - Fax:315-867-2717
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352655363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily