Healthcare Provider Details

I. General information

NPI: 1336607134
Provider Name (Legal Business Name): KATHRYN MINIKUS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HWY 31
FLEMINGTON NJ
08822-5812
US

IV. Provider business mailing address

11 VALLEY VIEW DR
FLEMINGTON NJ
08822-4507
US

V. Phone/Fax

Practice location:
  • Phone: 908-237-3405
  • Fax:
Mailing address:
  • Phone: 908-642-3803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ00909500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: