Basic Information
| Provider Information | |||||||||
| NPI: | 1265749857 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MINKS | ||||||||
| FirstName: | NAOMI | ||||||||
| MiddleName: | E | ||||||||
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| Mailing Information | |||||||||
| Address1: | 143 SOUTH GIBSON STREET | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544511622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7157482121 | ||||||||
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| Practice Location | |||||||||
| Address1: | 625 PETERSON AVE | ||||||||
| Address2: | |||||||||
| City: | PHILLIPS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545551452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153394035 | ||||||||
| FaxNumber: | 7153394036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2010 | ||||||||
| LastUpdateDate: | 05/22/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 4158-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.