Provider Demographics
NPI:1093734527
Name:CLEARY, MICHELLE A (NP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:CLEARY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 34929
Mailing Address - Street 2:P.O. BOX 39000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:925-952-2850
Practice Address - Street 1:380 CIVIC DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1988
Practice Address - Country:US
Practice Address - Phone:925-682-7871
Practice Address - Fax:925-682-7874
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP8668363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAONP86680Medicare PIN
CAP02192Medicare UPIN
CAEC172ZMedicare PIN