Healthcare Provider Details

I. General information

NPI: 1124939095
Provider Name (Legal Business Name): MADCHEN ISABELLE MIRANDA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL PLZ
STAMFORD CT
06902-3602
US

IV. Provider business mailing address

3700 RESERVOIR RD NW
WASHINGTON DC
20007-2111
US

V. Phone/Fax

Practice location:
  • Phone: 203-940-7994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number186516
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: