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General NPI Number Information
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NPI Number | 1215819628
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Entity Type | Individual
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Provider Name | MIRANDA KNOWLES
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Gender | Female
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Dates
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Enumeration Date | 07/24/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 4113 N 104TH PLZ
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City | OMAHA
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State | NE
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Zip | 68134-3781
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Country | US
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Telephone | 402-707-7052
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Fax |
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Provider Business Mailing Address
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Address Line | 4211 S 143RD CIR
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City | OMAHA
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State | NE
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Zip | 68137-4505
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 126741
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License Number State | NE
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