Healthcare Provider Details

I. General information

NPI: 1942133962
Provider Name (Legal Business Name): MIRANDA BOOTS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIRANDA JEAN SCHWAB

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E ROSSER AVE
BISMARCK ND
58501-4461
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-5741
  • Fax:
Mailing address:
  • Phone: 605-328-9419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number205206
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: