Provider Demographics
NPI:1598055246
Name:MINTER, EBONY LYNNELL (APRN)
Entity type:Individual
Prefix:MRS
First Name:EBONY
Middle Name:LYNNELL
Last Name:MINTER
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26600 RENAISSANCE PKWY
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5795
Mailing Address - Country:US
Mailing Address - Phone:216-306-0209
Mailing Address - Fax:
Practice Address - Street 1:26600 RENAISSANCE PKWY
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5795
Practice Address - Country:US
Practice Address - Phone:216-306-0209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH361937163W00000X
OHAPRN.CNP.0037450363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse