Healthcare Provider Details

I. General information

NPI: 1881515914
Provider Name (Legal Business Name): MIRANDA MARIE POPHAM ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIRANDA MARIE VANCE

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 CLAY ST STE 301
CEDAR FALLS IA
50613-2904
US

IV. Provider business mailing address

411 E POISAL ST
CLARKSVILLE IA
50619-7770
US

V. Phone/Fax

Practice location:
  • Phone: 319-214-0525
  • Fax:
Mailing address:
  • Phone: 319-231-6607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA192866
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: