Healthcare Provider Details

I. General information

NPI: 1700826427
Provider Name (Legal Business Name): SANDRA LYNN MINNICK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 A&B LAKE STREET
EPHRATA PA
17522-2415
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-721-7718
  • Fax: 717-721-7726
Mailing address:
  • Phone: 717-851-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberVP003366B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: