MEDICARE: MIRANDA MAE MUSE OHIO NURSE AIDE

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	376K00000X	Nurse's Aide	602478910422	OH

General Provider Information

NPI Number	:	1720824816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA MAE MUSE OHIO NURSE AIDE

Provider Business Mailing Address
First Line	:	3190 MCHENRY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-7343
Country	:	US
Telephone Number	:	513-375-8984
Fax Number	:

Provider Business Practice Location Address
First Line	:	3190 MCHENRY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-7343
Country	:	US
Telephone Number	:	513-375-8984
Fax Number	:

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

Provider Enumeration Date	:	07/08/2024
Last Update Date	:	07/08/2024

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