Healthcare Provider Details

I. General information

NPI: 1063486538
Provider Name (Legal Business Name): MINELA FERNANDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MINELA FERNANDEZ-APONTE MD

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

IV. Provider business mailing address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

V. Phone/Fax

Practice location:
  • Phone: 910-667-5011
  • Fax: 910-667-7390
Mailing address:
  • Phone: 910-667-5011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number201701734
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number33679
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: