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General NPI Number Information
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NPI Number | 1558922153
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Entity Type | Individual
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Provider Name | NICHOLAS JAMES MINISSALE DO
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Gender | Male
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 08/10/2025
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Provider Practice Location Address
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Address Line | 12100 BLACK SWAN DR STE 201
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City | LEWES
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State | DE
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Zip | 19958-4991
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Country | US
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Telephone | 302-644-3311
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Fax | 302-644-3300
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Provider Business Mailing Address
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Address Line | 550 17TH AVE STE 500
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City | SEATTLE
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State | WA
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Zip | 98122-5789
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Country | US
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Telephone | 206-320-2451
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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 | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | C2-0024693
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License Number State | DE
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