Healthcare Provider Details

I. General information

NPI: 1932984192
Provider Name (Legal Business Name): CHRISTINA ROSE MINENNA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 PARK ST
ATTLEBORO MA
02703-3137
US

IV. Provider business mailing address

211 PARK ST
ATTLEBORO MA
02703-3137
US

V. Phone/Fax

Practice location:
  • Phone: 508-222-5200
  • Fax: 508-236-7043
Mailing address:
  • Phone: 508-222-5200
  • Fax: 508-236-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA102042
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: