Provider Demographics
NPI:1932337318
Name:MENOTTI, MINDY D
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:D
Last Name:MENOTTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6228 SYCAMORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:AR
Mailing Address - Zip Code:71929-0401
Mailing Address - Country:US
Mailing Address - Phone:501-865-3363
Mailing Address - Fax:501-865-3362
Practice Address - Street 1:3399 FINCH RD
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:AR
Practice Address - Zip Code:71929-7541
Practice Address - Country:US
Practice Address - Phone:501-865-3363
Practice Address - Fax:501-865-3362
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator