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General NPI Number Information
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NPI Number | 1134460447
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Entity Type | Individual
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Provider Name | GINA M MINGA APRN, ACCNS-BC
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Gender | Female
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Dates
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Enumeration Date | 03/12/2013
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Last Update Date | 03/12/2013
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Provider Practice Location Address
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Address Line | 17800 KEDZIE AVE
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City | HAZEL CREST
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State | IL
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Zip | 60429-2029
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Country | US
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Telephone | 708-213-3288
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Fax | 708-213-2999
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Provider Business Mailing Address
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Address Line | 2700 HAWTHORNE LN
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City | FLOSSMOOR
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State | IL
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Zip | 60422-1514
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Country | US
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Telephone | 708-213-3288
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Fax | 708-213-2999
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | 209-004769
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License Number State | IL
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