Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 STOCKTON BLVD
SACRAMENTO CA
95817-1418
US

IV. Provider business mailing address

2321 EASTVIEW CT
SAN RAMON CA
94582-5386
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008401
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: