MEDICARE: AMY D MIRACLE CNM

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	367A00000X	Advanced Practice Midwife	RN260025	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710980891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY D MIRACLE CNM

Provider Business Mailing Address
First Line	:	5400 FRANTZ RD STE 250
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43016-6102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 OLENTANGY RIVER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3908
Country	:	US
Telephone Number	:	614-566-4378
Fax Number	:	614-533-1216

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	01/25/2022

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