Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 0024093498 | VA |
NPI | 1144426404 |
---|---|
Provider Name | Teri E Minehart |
First Address | Fairfax, VA 22031 |
Second Address | Arlington, VA 22205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2007 |
Last Update Date | 08/07/2007 |