Healthcare Provider Details

I. General information

NPI: 1073356143
Provider Name (Legal Business Name): ESRA MINNITI RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1471 CHESTER BLVD
RICHMOND IN
47374-1945
US

IV. Provider business mailing address

1100 REID HEALTH MEDICAL STAFF SERVICES
RICHMOND IN
47374
US

V. Phone/Fax

Practice location:
  • Phone: 765-983-3000
  • Fax:
Mailing address:
  • Phone: 765-935-8802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71015841A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28237246A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: