Healthcare Provider Details

I. General information

NPI: 1265105365
Provider Name (Legal Business Name): MINDY MARIE WARE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 DRUMMOND AVE
CHARLOTTE NC
28205-1918
US

IV. Provider business mailing address

1405 POINT ST APT 325
BALTIMORE MD
21231-3389
US

V. Phone/Fax

Practice location:
  • Phone: 501-772-6380
  • Fax:
Mailing address:
  • Phone: 501-772-6380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR106181
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number007212
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: