Healthcare Provider Details

I. General information

NPI: 1720052897
Provider Name (Legal Business Name): DAVID E MINGA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E 9TH ST
LONDON KY
40741-1204
US

IV. Provider business mailing address

740 E LAUREL RD
LONDON KY
40741-8601
US

V. Phone/Fax

Practice location:
  • Phone: 606-878-6520
  • Fax: 606-877-3978
Mailing address:
  • Phone: 606-877-3931
  • Fax: 606-877-3978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1953A
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: