MEDICARE: MIRANDA MOORE LPN

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	164W00000X	Licensed Practical Nurse	PN312848	PA

General Provider Information

NPI Number	:	1619551983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA MOORE LPN

Provider Business Mailing Address
First Line	:	301 SMITH DR STE 3
Second Line	:
City	:	CRANBERRY TOWNSHIP
State	:	PA
Zip	:	16066-4131
Country	:	US
Telephone Number	:	724-779-2010
Fax Number	:	724-779-2011

Provider Business Practice Location Address
First Line	:	301 SMITH DR STE 3
Second Line	:
City	:	CRANBERRY TOWNSHIP
State	:	PA
Zip	:	16066-4131
Country	:	US
Telephone Number	:	724-779-2010
Fax Number	:	724-779-2011

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

Provider Enumeration Date	:	05/12/2021
Last Update Date	:	05/12/2021

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Directions to “ MIRANDA MOORE LPN” Practice Location

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