Healthcare Provider Details

I. General information

NPI: 1891580296
Provider Name (Legal Business Name): MIRANDA ULMER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4070 HIGHWAY 17
MURRELLS INLET SC
29576-5033
US

IV. Provider business mailing address

7973 ELI CIR
TRUSSVILLE AL
35173-2472
US

V. Phone/Fax

Practice location:
  • Phone: 843-652-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-171028
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11043472
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024195612
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number31546
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: