Basic Information
| Provider Information | |||||||||
| NPI: | 1851995096 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MINOTTI | ||||||||
| FirstName: | CRISTINA | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DNP, RN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 925 VILLAGE HWY | ||||||||
| Address2: | |||||||||
| City: | RUSTBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245884591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4344552480 | ||||||||
| FaxNumber: | 4344552487 | ||||||||
| Practice Location | |||||||||
| Address1: | 925 VILLAGE HWY | ||||||||
| Address2: | |||||||||
| City: | RUSTBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245884591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4344552480 | ||||||||
| FaxNumber: | 4344552487 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2020 | ||||||||
| LastUpdateDate: | 12/17/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 0001292570 | VA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 0024180415 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.