Healthcare Provider Details

I. General information

NPI: 1356867147
Provider Name (Legal Business Name): MIRANDA DREYER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 08/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 MISSION GORGE RD STE O
SANTEE CA
92071-3027
US

IV. Provider business mailing address

7331 VIAR AVE
SAN DIEGO CA
92120-1927
US

V. Phone/Fax

Practice location:
  • Phone: 619-383-6868
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0812X
TaxonomyCommunity Psychiatric/Mental Health Clinical Nurse Specialist
License Number95118939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: