MEDICARE: ASHLEY MIRALDI

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	363LF0000X	Family Nurse Practitioner	AP60676444	WA

General Provider Information

NPI Number	:	1558713453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MIRALDI

Provider Business Mailing Address
First Line	:	18313 PAULSON ST SW
Second Line	:
City	:	ROCHESTER
State	:	WA
Zip	:	98579-9262
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18313 PAULSON ST SW
Second Line	:
City	:	ROCHESTER
State	:	WA
Zip	:	98579-9262
Country	:	US
Telephone Number	:	360-827-8400
Fax Number	:

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

Provider Enumeration Date	:	07/05/2016
Last Update Date	:	07/05/2016

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Directions to “ ASHLEY MIRALDI ” Practice Location

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