Healthcare Provider Details

I. General information

NPI: 1336124494
Provider Name (Legal Business Name): WILLIAM ANDREW MINTON SR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 AUBURN AVE
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

PO BOX 643179
CINCINNATI OH
45264-3179
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-0577
  • Fax:
Mailing address:
  • Phone: 937-293-0247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN.164877-COA1
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28143161A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: