MEDICARE: MIRANDA E GRIFFIN

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	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1033807698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA E GRIFFIN

Provider Business Mailing Address
First Line	:	101 DAUGHERTY ST # 5104
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76205-7330
Country	:	US
Telephone Number	:	940-268-3106
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 DAUGHERTY ST # 5104
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76205-7330
Country	:	US
Telephone Number	:	940-268-3106
Fax Number	:

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

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	05/01/2023

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Directions to “ MIRANDA E GRIFFIN ” Practice Location

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