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General NPI Number Information
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NPI Number | 1265871545
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Entity Type | Individual
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Provider Name | MIRANDA JEAN FELTY
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Gender | Female
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Dates
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Enumeration Date | 06/19/2013
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Last Update Date | 07/09/2015
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Provider Practice Location Address
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Address Line | 110 S 17TH ST
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City | HARRISBURG
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State | PA
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Zip | 17104-1123
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Country | US
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Telephone | 717-232-9971
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Fax |
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Provider Business Mailing Address
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Address Line | 6130 SPRINGFORD DR APT J6
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City | HARRISBURG
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State | PA
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Zip | 17111-6876
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA056148
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License Number State | PA
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