Individual
JENNIFER MINTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
118 W DREXEL PKWY, RENSSELAER, IN 47978-7344
(219) 866-4300
(219) 866-7591
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71002930A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201287460
—
IN
01
—
815150022
MEDICARE PTAN
IN
Enumeration date
04/07/2015
Last updated
10/12/2023
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