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General NPI Number Information
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NPI Number | 1891083713
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Entity Type | Individual
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Provider Name | STACEY M MINTER D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 3506 KENNETT PIKE STE 100
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City | WILMINGTON
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State | DE
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Zip | 19807-3019
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Country | US
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Telephone | 302-661-3375
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Fax | 302-661-3374
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Provider Business Mailing Address
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Address Line | PO BOX 10097
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City | CASA GRANDE
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State | AZ
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Zip | 85130-0020
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Country | US
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Telephone | 520-836-3446
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 007592
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | C2-0024392
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License Number State | DE
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