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General NPI Number Information
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NPI Number | 1922889849
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Entity Type | Individual
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Provider Name | MIRANDA KAAKE MS, PA (ASCP)
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Gender | Female
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Dates
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Enumeration Date | 10/06/2023
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 1 MEDICAL VILLAGE DR
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City | EDGEWOOD
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State | KY
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Zip | 41017-3403
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Country | US
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Telephone | 513-301-2542
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Fax |
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Provider Business Mailing Address
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Address Line | 145 INDIAN CREEK DR
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City | COVINGTON
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State | KY
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Zip | 41017-9139
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Country | US
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Telephone | 812-972-1351
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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 | 246RM2200X
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Taxonomy Name | Medical Laboratory Technician
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License Number |
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License Number State |
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