Healthcare Provider Details

I. General information

NPI: 1093638629
Provider Name (Legal Business Name): CERICE MICHELLE M MINER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 W LEGION
WAUNETA NE
69045-4551
US

IV. Provider business mailing address

342 W LEGION
WAUNETA NE
69045-4551
US

V. Phone/Fax

Practice location:
  • Phone: 208-272-1973
  • Fax:
Mailing address:
  • Phone: 208-272-1973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number117111
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: