Provider Demographics
NPI:1962808949
Name:MINARCIK, EMILIE (NP)
Entity type:Individual
Prefix:MRS
First Name:EMILIE
Middle Name:
Last Name:MINARCIK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:EMILIE
Other - Middle Name:S
Other - Last Name:FAGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1000 MON HEALTH MEDICAL PARK DR STE 1104
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1143
Mailing Address - Country:US
Mailing Address - Phone:304-598-7296
Mailing Address - Fax:304-598-7297
Practice Address - Street 1:1000 MON HEALTH MEDICAL PARK DR STE 1104
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1143
Practice Address - Country:US
Practice Address - Phone:304-598-7296
Practice Address - Fax:304-598-7297
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1638693363L00000X
PASP014335363LA2100X
CO992330363LA2100X
WV106888363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
COMF3415610OtherDEA
CO511332YLSHMedicare PIN