MEDICARE: CECILE ESTELLE MINDEMANN RN

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	163WC0400X	Case Management Registered Nurse	64345	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	64345	OTHER	OK	REGISTERED NURSE

General Provider Information

NPI Number	:	1417627332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECILE ESTELLE MINDEMANN RN

Provider Business Mailing Address
First Line	:	PO BOX 343
Second Line	:
City	:	APACHE
State	:	OK
Zip	:	73006-0343
Country	:	US
Telephone Number	:	580-704-8089
Fax Number	:

Provider Business Practice Location Address
First Line	:	3161 HOSKINS RD
Second Line	:
City	:	FORT SILL
State	:	OK
Zip	:	73503-4462
Country	:	US
Telephone Number	:	580-704-8089
Fax Number	:

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

Provider Enumeration Date	:	09/14/2021
Last Update Date	:	09/14/2021

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