Healthcare Provider Details

I. General information

NPI: 1659886943
Provider Name (Legal Business Name): MIRANDA DREW FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7280 LAGAE RD STE I
CASTLE PINES CO
80108-9454
US

IV. Provider business mailing address

1805 SHEA CENTER DR STE 301
HIGHLANDS RANCH CO
80129-2277
US

V. Phone/Fax

Practice location:
  • Phone: 303-814-0505
  • Fax:
Mailing address:
  • Phone: 303-814-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0182512
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0995691
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: