Basic Information
| Provider Information | |||||||||
| NPI: | 1881751840 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MINOR | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | STEPHEN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | RN MSN ACNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 890195 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282890195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365471700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 520 N ELAM AVE | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274031127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365471700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 065421 | NC | X | Nursing Service Providers | Registered Nurse | 363LA2100X | 600095 | NC | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | E2608 | 01 | NC | MEDCOST | OTHER | 7003728 | 05 | NC | MEDICAID |