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NPI Code Detail

MEDICARE: MARTHA MIRANDA ALICEA RN

MEDICARE: MARTHA MIRANDA ALICEA RN
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
1163W00000XRegistered NurseR182896-4MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1868K1CAOTHERMNBCBS

General Provider Information

NPI Number : 1952612806
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA MIRANDA ALICEA RN
Provider Business Mailing Address
First Line : 2236 MARSHALL AVE
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-5799
Country : US
Telephone Number : 651-659-0208
Fax Number : 651-659-0161
Provider Business Practice Location Address
First Line : 2236 MARSHALL AVE
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-5799
Country : US
Telephone Number : 651-659-0208
Fax Number : 651-659-0161
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2010
Last Update Date : 06/25/2010

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