MEDICARE: MRS. GRETA SUE MINTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	APN000005830	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114928363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRETA SUE MINTON

Provider Business Mailing Address
First Line	:	2413 S CHANCERY ST
Second Line	:
City	:	MCMINNVILLE
State	:	TN
Zip	:	37110-3614
Country	:	US
Telephone Number	:	931-668-2273
Fax Number	:	931-815-2305

Provider Business Practice Location Address
First Line	:	2413 SOUTH CHANCERY STREET
Second Line	:
City	:	MCMINNVILLE
State	:	TN
Zip	:	37110
Country	:	UM
Telephone Number	:	931-668-2273
Fax Number	:	931-815-2305

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	05/13/2015

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