Basic Information
| Provider Information | |||||||||
| NPI: | 1487772943 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MINER | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | G.M. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 587 MIDDLE TPKE E | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060403731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606463888 | ||||||||
| FaxNumber: | 8606454132 | ||||||||
| Practice Location | |||||||||
| Address1: | 587 MIDDLE TPKE E | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060403731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606463888 | ||||||||
| FaxNumber: | 8606454132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 05/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 002358 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 004040655 | 05 | CT | MEDICAID |