MEDICARE: MIRANDA CHANDLER RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	1184897	AL
2	363LF0000X	Family Nurse Practitioner	1-184897	AL

General Provider Information

NPI Number	:	1003575689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA CHANDLER RN

Provider Business Mailing Address
First Line	:	13280 COPELAND ISLAND DR S
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36695-6614
Country	:	US
Telephone Number	:	251-366-1849
Fax Number	:

Provider Business Practice Location Address
First Line	:	324 COMMONS DR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-6962
Country	:	US
Telephone Number	:	251-366-1849
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2021
Last Update Date	:	09/05/2025

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