Healthcare Provider Details

I. General information

NPI: 1457267726
Provider Name (Legal Business Name): MIRANDA MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5334 S 136TH ST
OMAHA NE
68137-3001
US

IV. Provider business mailing address

15020 DORCAS CIR
OMAHA NE
68144-2039
US

V. Phone/Fax

Practice location:
  • Phone: 402-759-9665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0927
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: