Healthcare Provider Details

I. General information

NPI: 1548021199
Provider Name (Legal Business Name): MIRANDA ROSE MARING NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 NE 139TH ST STE 450
VANCOUVER WA
98686-2325
US

IV. Provider business mailing address

1820 SE CUTTER LN
VANCOUVER WA
98661-8086
US

V. Phone/Fax

Practice location:
  • Phone: 360-487-4848
  • Fax:
Mailing address:
  • Phone: 360-749-2661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61519437
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60648751
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: