Healthcare Provider Details

I. General information

NPI: 1386142487
Provider Name (Legal Business Name): MISS EDORIS MINNIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TEMPLE UNIVERSITY HOSPITAL 3401 NORTH BROAD STREET
PHILADELPHIA PA
19140
US

IV. Provider business mailing address

TEMPLE UNIVERSITY HOSPITAL - BOYER PAVILION 3509 N. BROAD STREET
PHILADELPHIA PA
19140
US

V. Phone/Fax

Practice location:
  • Phone: 267-273-3379
  • Fax:
Mailing address:
  • Phone: 267-273-3379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: