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NPI Code Detail

MEDICARE: MARY JANE MINNICK ACNP

MEDICARE: MARY JANE MINNICK ACNP
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
1363L00000XNurse Practitioner11823TN

General Provider Information

NPI Number : 1194796557
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY JANE MINNICK ACNP
Provider Business Mailing Address
First Line : 1915 WHITE AVE
Second Line :
City : KNOXVILLE
State : TN
Zip : 37916-2300
Country : US
Telephone Number : 865-541-1720
Fax Number : 865-541-1747
Provider Business Practice Location Address
First Line : 1915 WHITE AVE
Second Line :
City : KNOXVILLE
State : TN
Zip : 37916-2300
Country : US
Telephone Number : 865-541-1720
Fax Number : 865-541-1747
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2006
Last Update Date : 03/17/2018

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