Healthcare Provider Details

I. General information

NPI: 1265807143
Provider Name (Legal Business Name): MIRIAM ORUCHO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 08/14/2021
Certification Date: 08/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2234 145TH AVE NW
ANDOVER MN
55304-3345
US

IV. Provider business mailing address

2234 145TH AVE NW
ANDOVER MN
55304-3345
US

V. Phone/Fax

Practice location:
  • Phone: 763-516-8536
  • Fax:
Mailing address:
  • Phone: 763-516-8536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR 203411-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: