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NPI Code Detail

MEDICARE: MRS. COLLEEN KRISTINA MIRANDA CNP

MEDICARE: MRS. COLLEEN KRISTINA MIRANDA CNP
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
1363LF0000XFamily Nurse PractitionerRN 204202OH

General Provider Information

NPI Number : 1023122470
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. COLLEEN KRISTINA MIRANDA CNP
Provider Business Mailing Address
First Line : 85 VIRGINIA AVE
Second Line :
City : WASHINGTON TOWNSHIP
State : OH
Zip : 45458-2246
Country : US
Telephone Number : 937-475-8775
Fax Number :
Provider Business Practice Location Address
First Line : 4961 ROBERTS RD
Second Line :
City : HILLIARD
State : OH
Zip : 43026-8129
Country : US
Telephone Number : 937-475-8775
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2006
Last Update Date : 07/08/2007

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