Healthcare Provider Details

I. General information

NPI: 1417674755
Provider Name (Legal Business Name): BETTY MINTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 EAST 2ND STREET
UNITY WI
54488-0136
US

IV. Provider business mailing address

PO BOX 136
UNITY WI
54488-0136
US

V. Phone/Fax

Practice location:
  • Phone: 715-223-6435
  • Fax:
Mailing address:
  • Phone: 715-223-6435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number91700-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: