Healthcare Provider Details

I. General information

NPI: 1154496305
Provider Name (Legal Business Name): MINTER NUTRITION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20111 REGINA RD
NEW PARIS IN
46553-9632
US

IV. Provider business mailing address

PO BOX 629 20111 REGINA ROAD
NEW PARIS IN
46553-0629
US

V. Phone/Fax

Practice location:
  • Phone: 574-202-0704
  • Fax: 574-831-6795
Mailing address:
  • Phone: 574-202-0704
  • Fax: 574-831-6795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37000537A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number37000537A
License Number StateIN

VIII. Authorized Official

Name: MS. KARLA JEAN MINTER
Title or Position: PRESIDENT
Credential: MPH, RD, CD
Phone: 574-202-0704