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Individual

JESSE D MINOR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNP

Contact information

Practice address
45 PINE STREET, PORT ALLEGANY, PA 16915
(814) 642-9655
Mailing address
1001 E 2ND ST, COUDERSPORT, PA 16915-8161
(814) 274-9300

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SP024095
PA

Other

Enumeration date
08/06/2021
Last updated
08/06/2021
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