Healthcare Provider Details

I. General information

NPI: 1063350619
Provider Name (Legal Business Name): HELEN MIRANDA DNP AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8902 OLCOTT AVE
MORTON GROVE IL
60053-1916
US

IV. Provider business mailing address

8902 OLCOTT AVE
MORTON GROVE IL
60053-1916
US

V. Phone/Fax

Practice location:
  • Phone: 847-208-5484
  • Fax:
Mailing address:
  • Phone: 847-208-5484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209031514
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: