Provider Demographics
NPI:1174520100
Name:MCMINN, DENISE L (RN, MSN, WHNP-BC)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:L
Last Name:MCMINN
Suffix:
Gender:F
Credentials:RN, MSN, WHNP-BC
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Mailing Address - Street 1:PO BOX 6730
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6730
Mailing Address - Country:US
Mailing Address - Phone:480-917-6480
Mailing Address - Fax:480-821-3610
Practice Address - Street 1:8410 W THOMAS RD
Practice Address - Street 2:STE 134
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3329
Practice Address - Country:US
Practice Address - Phone:623-907-2377
Practice Address - Fax:480-857-2667
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX555118363LW0102X
NMCNP-02372363LW0102X
AZAP5758363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX070872901Medicaid
TX070872901Medicaid