Provider Demographics
NPI:1952398109
Name:MINER, MARY JEANNE (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JEANNE
Last Name:MINER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHICO STATE UNIVERSITY STUDENT HEALTH
Mailing Address - Street 2:WARNER AVE & COLLEGE DR
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95929-0001
Mailing Address - Country:US
Mailing Address - Phone:530-898-5241
Mailing Address - Fax:530-898-4057
Practice Address - Street 1:CHICO STATE UNIVERSITY STUDENT HEALTH
Practice Address - Street 2:WARNER AVE & COLLEGE DR
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95929-0001
Practice Address - Country:US
Practice Address - Phone:530-898-5241
Practice Address - Fax:530-898-4057
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 14975363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP 14975OtherNURSE PRACTITIONER CERTIF
CARN271495Medicaid
CANPF 14975OtherNP FURNISHING NUMBER
CARN 271495OtherRN LICENSE NUMBER
CARN 271495OtherRN LICENSE NUMBER