Provider Demographics
NPI:1386891067
Name:UTATE, MINERVA ALTAGRACIA (NP)
Entity type:Individual
Prefix:MS
First Name:MINERVA
Middle Name:ALTAGRACIA
Last Name:UTATE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4744
Mailing Address - Country:US
Mailing Address - Phone:212-731-5577
Mailing Address - Fax:212-731-6024
Practice Address - Street 1:160 E 34TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4744
Practice Address - Country:US
Practice Address - Phone:212-731-5577
Practice Address - Fax:212-731-6024
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304972-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health