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NPI Code Detail

MEDICARE: MYRANDA FIELDS

MEDICARE:   MYRANDA  FIELDS
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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1629586938
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYRANDA FIELDS
Provider Business Mailing Address
First Line : 2212 BELLAMY CIR APT 122
Second Line :
City : GREENVILLE
State : NC
Zip : 27858-7211
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 600 W ARLINGTON BLVD
Second Line :
City : GREENVILLE
State : NC
Zip : 27834-5724
Country : US
Telephone Number : 252-321-3640
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2018
Last Update Date : 01/21/2018

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Directions to “ MYRANDA FIELDS ” Practice Location

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