=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093638629
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CERICE MICHELLE M MINER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2026
-----------------------------------------------------
Last Update Date | 07/31/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 342 W LEGION
-----------------------------------------------------
City | WAUNETA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 69045-4551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-272-1973
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 342 W LEGION
-----------------------------------------------------
City | WAUNETA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 69045-4551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-272-1973
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 117111
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------