Healthcare Provider Details

I. General information

NPI: 1750007985
Provider Name (Legal Business Name): LORETTA MINOR CNP, AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 MAIN ST SUITE 1
BALDWIN WI
54002
US

IV. Provider business mailing address

990 MAIN ST SUITE 1
BALDWIN WI
54002
US

V. Phone/Fax

Practice location:
  • Phone: 715-629-1888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9609
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: