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General NPI Number Information
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NPI Number | 1831118512
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Entity Type | Individual
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Provider Name | SUSANNA MIRANDA DNP, APRN, AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | 676 N SAINT CLAIR ST FL 19
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City | CHICAGO
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State | IL
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Zip | 60611-2927
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Country | US
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Telephone | 312-695-8900
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Fax | 312-695-7752
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Provider Business Mailing Address
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Address Line | 676 N SAINT CLAIR ST FL 19
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City | CHICAGO
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State | IL
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Zip | 60611-2927
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Country | US
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Telephone | 312-695-8900
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Fax | 312-695-7752
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041-332458
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 209-017775
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209017775
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License Number State | IL
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