Individual
MRS. NATOSHA E. MINICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
11109 PARKVIEW PLAZA DR., FORT WAYNE, IN 46845-1701
(260) 266-2020
(260) 266-2009
Mailing address
1234 E. DUPONT RD., STE 1, FORT WAYNE, IN 46825-1545
(260) 373-9700
(260) 373-9740
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28162741A
IN
363L00000X
Nurse Practitioner
Primary
71002766A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000739557
ANTHEM
IN
05
—
0057278
—
IN
05
—
200920620
—
IN
Enumeration date
09/15/2008
Last updated
03/23/2013
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