Healthcare Provider Details

I. General information

NPI: 1699881797
Provider Name (Legal Business Name): MIRANDA BACHMAN LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIRANDA HARRIS LMP

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 W HOOD PL SUITE102
KENNEWICK WA
99336-6714
US

IV. Provider business mailing address

7101 W HOOD PL SUITE102
KENNEWICK WA
99336-6719
US

V. Phone/Fax

Practice location:
  • Phone: 509-374-4729
  • Fax: 509-374-3873
Mailing address:
  • Phone: 509-374-4729
  • Fax: 509-374-3873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00010231
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: