Provider Demographics
NPI:1285737775
Name:MINTS, KRYSTINA M (CRNP)
Entity type:Individual
Prefix:MS
First Name:KRYSTINA
Middle Name:M
Last Name:MINTS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 MOUNTAIN RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2018
Mailing Address - Country:US
Mailing Address - Phone:410-360-4446
Mailing Address - Fax:410-360-4449
Practice Address - Street 1:3100 MOUNTAIN RD
Practice Address - Street 2:SUITE E
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2018
Practice Address - Country:US
Practice Address - Phone:410-360-4446
Practice Address - Fax:410-360-4449
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR160139363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD521116591OtherCOVENTRY
MD521116591OtherMARYLAND PHYSICIANS CARE
MD759524OtherNCPPO
MDT5880038OtherCF BC/BS GRP/GHMSI/BL CHO
MD521116591OtherINFORMED
MD6560084OtherCIGNA
MD112728OtherPRIORITY PARTNERS
MD61308701OtherCAREFIRST BC/BS RENDERING
MD521116591OtherTRICARE
MD784381000Medicaid
MDW6420009OtherBCBS
S135P019Medicare PIN