Healthcare Provider Details

I. General information

NPI: 1205498342
Provider Name (Legal Business Name): MIRANDA MILLIE GEBHART NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N 7TH ST
CHARITON IA
50049-1210
US

IV. Provider business mailing address

215 S SPRUCE ST
INDIANOLA IA
50125-4108
US

V. Phone/Fax

Practice location:
  • Phone: 641-774-8103
  • Fax: 641-774-8087
Mailing address:
  • Phone: 712-490-7634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA155248
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: