MEDICARE: MIRANDA ALEXIS-MARTIN WHITEHEAD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WI0600X	Infection Control Registered Nurse	0001280462	VA

General Provider Information

NPI Number	:	1700584984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA ALEXIS-MARTIN WHITEHEAD

Provider Business Mailing Address
First Line	:	438 WALTONS MOUNTAIN RD
Second Line	:
City	:	NEW CASTLE
State	:	VA
Zip	:	24127-8691
Country	:	US
Telephone Number	:	540-588-8555
Fax Number	:

Provider Business Practice Location Address
First Line	:	438 WALTONS MOUNTAIN RD
Second Line	:
City	:	NEW CASTLE
State	:	VA
Zip	:	24127-8691
Country	:	US
Telephone Number	:	540-588-8555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2023
Last Update Date	:	02/17/2023

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Directions to “ MIRANDA ALEXIS-MARTIN WHITEHEAD ” Practice Location

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