Provider Demographics
NPI:1386142487
Name:MINNIS, EDORIS
Entity type:Individual
Prefix:MISS
First Name:EDORIS
Middle Name:
Last Name:MINNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TEMPLE UNIVERSITY HOSPITAL - BOYER PAVILION
Mailing Address - Street 2:3509 N. BROAD STREET
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140
Mailing Address - Country:US
Mailing Address - Phone:267-273-3379
Mailing Address - Fax:
Practice Address - Street 1:TEMPLE UNIVERSITY HOSPITAL
Practice Address - Street 2:3401 NORTH BROAD STREET
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140
Practice Address - Country:US
Practice Address - Phone:267-273-3379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator