MEDICARE: MONICA MINDEMANN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	64369	OK

General Provider Information

NPI Number	:	1083003750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA MINDEMANN

Provider Business Mailing Address
First Line	:	4134 COUNTY STREET 2760
Second Line	:
City	:	RUSH SPRINGS
State	:	OK
Zip	:	73082-3069
Country	:	US
Telephone Number	:	580-476-3332
Fax Number	:

Provider Business Practice Location Address
First Line	:	4134 COUNTY STREET 2760
Second Line	:
City	:	RUSH SPRINGS
State	:	OK
Zip	:	73082-3069
Country	:	US
Telephone Number	:	580-476-3332
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2015
Last Update Date	:	01/17/2015

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