Provider Demographics
NPI:1285624106
Name:MINER, JOHNETTA (NP)
Entity type:Individual
Prefix:MS
First Name:JOHNETTA
Middle Name:
Last Name:MINER
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Gender:F
Credentials:NP
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Mailing Address - Street 1:140 DARROW PL
Mailing Address - Street 2:SUITE 16B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-1802
Mailing Address - Country:US
Mailing Address - Phone:718-379-1290
Mailing Address - Fax:718-379-8597
Practice Address - Street 1:140 DARROW PL
Practice Address - Street 2:SUITE 16B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-1802
Practice Address - Country:US
Practice Address - Phone:718-379-1290
Practice Address - Fax:718-379-8597
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-22
Last Update Date:2010-10-27
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Provider Licenses
StateLicense IDTaxonomies
NYF420329-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02241798Medicaid
NYS87741Medicare UPIN