Provider Demographics
NPI:1346983889
Name:OLIVER, MIRANDA NICOLE (NP-C)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:NICOLE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 DEL NORTE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4142
Mailing Address - Country:US
Mailing Address - Phone:530-751-7201
Mailing Address - Fax:530-751-2704
Practice Address - Street 1:370 DEL NORTE AVE STE 201
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4142
Practice Address - Country:US
Practice Address - Phone:307-517-2015
Practice Address - Fax:530-751-2704
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020631363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily