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General NPI Number Information
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NPI Number | 1508391210
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Entity Type | Individual
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Provider Name | VIVIAN MARIE MINKEMEYER M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/01/2017
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 3400 WAKE FOREST RD
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City | RALEIGH
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State | NC
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Zip | 27609-7317
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Country | US
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Telephone | 919-954-3624
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 WAKE FOREST RD
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City | RALEIGH
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State | NC
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Zip | 27609-7317
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Country | US
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Telephone | 919-954-3624
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2021-01121
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License Number State | NC
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