Healthcare Provider Details

I. General information

NPI: 1609876242
Provider Name (Legal Business Name): DEBRA J MINCHOW ADULT/GERIATRIC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 SW COAST HWY STE 201
NEWPORT OR
97365-5240
US

IV. Provider business mailing address

3015 NE WEST DEVILS LAKE RD
LINCOLN CITY OR
97367-5131
US

V. Phone/Fax

Practice location:
  • Phone: 541-265-8816
  • Fax:
Mailing address:
  • Phone: 541-994-5591
  • Fax: 541-996-7294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number200550111NP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number200550112NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: