Healthcare Provider Details

I. General information

NPI: 1871773937
Provider Name (Legal Business Name): RENEE MARIE MINOTTI PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 BELMONT AVE
YOUNGSTOWN OH
44504-1106
US

IV. Provider business mailing address

1815 BELMONT AVE
YOUNGSTOWN OH
44504-1106
US

V. Phone/Fax

Practice location:
  • Phone: 330-740-9200
  • Fax: 216-229-2974
Mailing address:
  • Phone: 330-740-9200
  • Fax: 216-229-2974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP12255
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRNCNP12255
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: