MEDICARE: NICOLE JOY MINNICH

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	363A00000X	Physician Assistant	10004130A	IN

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	:	1922712058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE JOY MINNICH

Provider Business Mailing Address
First Line	:	3245 HEALTH DR STE 100
Second Line	:
City	:	GRANGER
State	:	IN
Zip	:	46530-1380
Country	:	US
Telephone Number	:	574-647-3725
Fax Number	:

Provider Business Practice Location Address
First Line	:	6913 N MAIN ST
Second Line	:
City	:	GRANGER
State	:	IN
Zip	:	46530-8039
Country	:	US
Telephone Number	:	574-647-1500
Fax Number	:	574-243-4306

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

Provider Enumeration Date	:	01/12/2023
Last Update Date	:	01/05/2026

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Directions to “ NICOLE JOY MINNICH ” Practice Location

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