Healthcare Provider Details

I. General information

NPI: 1285132175
Provider Name (Legal Business Name): GERDY MIRLINE PLUVIOSE- ANIAGU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13555 BOWMAN RD STE 100
AUBURN CA
95603-3197
US

IV. Provider business mailing address

3017 SKY WATCH WAY
ROSEVILLE CA
95747-9378
US

V. Phone/Fax

Practice location:
  • Phone: 530-885-3951
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1220019
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008401
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: