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General NPI Number Information
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NPI Number | 1932730447
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Entity Type | Organization
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Legal Business Name | MIRANOVA HEALTH PLLC
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Dates
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Enumeration Date | 02/03/2020
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 715 9TH AVE
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City | SEATTLE
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State | WA
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Zip | 98104-2066
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Country | US
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Telephone | 206-902-4582
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Fax | 206-902-4159
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Provider Business Mailing Address
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Address Line | PO BOX 21249
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City | SEATTLE
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State | WA
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Zip | 98111-3249
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Country | US
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Telephone | 206-902-4582
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Fax | 206-902-4159
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | EMILY NANCY HANSON
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Credential | MD
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Telephone | 952-240-4258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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