Basic Information
Provider Information
NPI: 1336176684
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MINIKIEWICZ
FirstName: APRIL
MiddleName: SHERRY
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4416 FOREST DR
Address2: 2ND FLOOR
City: COLUMBIA
State: SC
PostalCode: 292063104
CountryCode: US
TelephoneNumber: 8037824278
FaxNumber: 8037823445
Practice Location
Address1: 247 COLUMBIA AVE
Address2:  
City: LEXINGTON
State: SC
PostalCode: 290722611
CountryCode: US
TelephoneNumber: 8033595533
FaxNumber: 8033590127
Other Information
ProviderEnumerationDate: 06/26/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X308SCY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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