Provider Demographics
NPI:1669509501
Name:MINOR, MICHELLE L (RN PNP MN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:MINOR
Suffix:
Gender:F
Credentials:RN PNP MN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 WELCH RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1455 MONTEGO
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2990
Practice Address - Country:US
Practice Address - Phone:925-932-2402
Practice Address - Fax:925-932-2456
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA265241363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics