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NPI Code Detail

MEDICARE: MIRANDA TAYLOR LVN

MEDICARE: MIRANDA TAYLOR LVN
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
1164X00000XLicensed Vocational Nurse308887TX

General Provider Information

NPI Number : 1396245023
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRANDA TAYLOR LVN
Provider Business Mailing Address
First Line : 314 COUNTY ROAD 4213
Second Line :
City : DECATUR
State : TX
Zip : 76234-5307
Country : US
Telephone Number : 817-372-1058
Fax Number :
Provider Business Practice Location Address
First Line : 314 COUNTY ROAD 4213
Second Line :
City : DECATUR
State : TX
Zip : 76234-5307
Country : US
Telephone Number : 817-372-1058
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2018
Last Update Date : 02/19/2018

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Directions to “ MIRANDA TAYLOR LVN” Practice Location

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