Healthcare Provider Details

I. General information

NPI: 1902297112
Provider Name (Legal Business Name): MINGO FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MCLISTER AVE SUITE B
MINGO JUNCTION OH
43938-1259
US

IV. Provider business mailing address

116 MCLISTER AVE SUITE B
MINGO JUNCTION OH
43938-1259
US

V. Phone/Fax

Practice location:
  • Phone: 740-535-8025
  • Fax: 740-535-8079
Mailing address:
  • Phone: 740-535-8025
  • Fax: 740-535-8079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.16767-NP
License Number StateOH

VIII. Authorized Official

Name: DR. MELISSA LOUISE VOSTATEK
Title or Position: OWNER
Credential: PHARMD
Phone: 740-535-8025