Provider Demographics
NPI:1508658758
Name:MINTA WELLNESS INNOVATIONS LLC
Entity type:Organization
Organization Name:MINTA WELLNESS INNOVATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BARNES-BLOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:240-994-3962
Mailing Address - Street 1:235 MILL ST STE 2
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6668
Mailing Address - Country:US
Mailing Address - Phone:240-347-1807
Mailing Address - Fax:
Practice Address - Street 1:235 MILL ST STE 2
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6668
Practice Address - Country:US
Practice Address - Phone:240-347-1807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain