Healthcare Provider Details

I. General information

NPI: 1114340767
Provider Name (Legal Business Name): ANNETTE EASLEY MINTER AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 RISON ST STE 120
DANVILLE VA
24541-2426
US

IV. Provider business mailing address

501 RISON ST STE 120
DANVILLE VA
24541-2426
US

V. Phone/Fax

Practice location:
  • Phone: 434-792-3730
  • Fax: 434-792-6048
Mailing address:
  • Phone: 434-792-3730
  • Fax: 434-792-6048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024171370
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: