Basic Information
| Provider Information | |||||||||
| NPI: | 1922004068 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MINCHHOFF | ||||||||
| FirstName: | DOLORES | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 398 MARTIC HEIGHTS DR | ||||||||
| Address2: | |||||||||
| City: | HOLTWOOD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175329679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172842065 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 620 SPEAR ST | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193631655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109329300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2005 | ||||||||
| LastUpdateDate: | 07/01/2010 | ||||||||
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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 | VP005714B | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | VP005714B | 01 | PA | LICENSE NUMBER | OTHER |