Provider Demographics
NPI:1740374479
Name:MINICLIER, MARGARET CAMERON (NP)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:CAMERON
Last Name:MINICLIER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:PHILO
Mailing Address - State:CA
Mailing Address - Zip Code:95466-0444
Mailing Address - Country:US
Mailing Address - Phone:707-489-6619
Mailing Address - Fax:
Practice Address - Street 1:844 S DORA ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5711
Practice Address - Country:US
Practice Address - Phone:707-462-8603
Practice Address - Fax:707-462-8605
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1144207671Medicare UPIN
CAZZZ15881ZMedicare ID - Type Unspecified