Individual
KIMBERLY MINICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
602 F ST, LA PORTE, IN 46350-5526
(219) 324-1377
Mailing address
2022 KELLE DR, CHESTERTON, IN 46304-8708
(219) 326-2312
(219) 326-2584
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71003346A
IN
363LF0000X
Family Nurse Practitioner
PENDING
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000711729
ANTHEM BCBS
IN
05
—
201004380
—
IN
01
—
P00999289
RAILROAD MEDICARE
IN
Enumeration date
08/09/2010
Last updated
01/13/2021
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