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General NPI Number Information
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NPI Number | 1932637725
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Entity Type | Individual
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Provider Name | MIRANDA LARAE VANCIL APRN
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Gender | Female
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Dates
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Enumeration Date | 05/24/2017
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 307 W HWY 54 STE 300
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City | ANDOVER
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State | KS
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Zip | 67002-7849
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Country | US
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Telephone | 316-218-0008
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Fax | 162-180-0033
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Provider Business Mailing Address
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Address Line | 1410 N WOODLAWN BLVD
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City | DERBY
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State | KS
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Zip | 67037-2953
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Country | US
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Telephone | 316-788-3741
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Fax | 316-788-5198
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 53-77657
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License Number State | KS
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