Provider Demographics
NPI:1134460447
Name:MINGA, GINA M (APRN, ACCNS-BC)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:M
Last Name:MINGA
Suffix:
Gender:F
Credentials:APRN, ACCNS-BC
Other - Prefix:MISS
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:SPIEKHOUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, ACCNS-BC
Mailing Address - Street 1:2700 HAWTHORNE LN
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1514
Mailing Address - Country:US
Mailing Address - Phone:708-213-3288
Mailing Address - Fax:708-213-2999
Practice Address - Street 1:17800 KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2029
Practice Address - Country:US
Practice Address - Phone:708-213-3288
Practice Address - Fax:708-213-2999
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-004769364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health