Provider Demographics
NPI:1346585122
Name:MINOR, MARIANNE ETHEL (RN, ANP)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:ETHEL
Last Name:MINOR
Suffix:
Gender:F
Credentials:RN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2457 N HELIOTROPE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-1618
Mailing Address - Country:US
Mailing Address - Phone:714-504-8424
Mailing Address - Fax:714-835-2042
Practice Address - Street 1:2457 N HELIOTROPE DR
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-1618
Practice Address - Country:US
Practice Address - Phone:714-504-8424
Practice Address - Fax:714-835-2042
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAM288325363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health