Healthcare Provider Details

I. General information

NPI: 1538754783
Provider Name (Legal Business Name): MIRANDA HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 GRAYBARN CIR
LEWISBURG WV
24901-5912
US

IV. Provider business mailing address

119 GRAYBARN CIR
LEWISBURG WV
24901-5912
US

V. Phone/Fax

Practice location:
  • Phone: 304-661-5171
  • Fax:
Mailing address:
  • Phone: 304-661-5171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: