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General NPI Number Information
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NPI Number | 1891736187
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Entity Type | Individual
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Provider Name | SANDRA GAY MINIX RD, CD
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Gender | Female
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 11/25/2013
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Provider Practice Location Address
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Address Line | 600 EAST BLVD DEPT OF NUTRITION
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City | ELKHART
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State | IN
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Zip | 46514-2483
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Country | US
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Telephone | 574-524-7474
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Fax | 574-296-6504
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Provider Business Mailing Address
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Address Line | 600 EAST BLVD
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City | ELKHART
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State | IN
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Zip | 46514-2483
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Country | US
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Telephone | 574-524-7474
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LD002665
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License Number State | GA
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