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NPI Code Detail

MEDICARE: MIRANDA ROSE BELLANTONI NP

MEDICARE: MIRANDA ROSE BELLANTONI NP
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
1363LF0000XFamily Nurse Practitioner0994510CO

General Provider Information

NPI Number : 1760949309
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRANDA ROSE BELLANTONI NP
Provider Business Mailing Address
First Line : 7030 S YOSEMITE ST
Second Line : STE 210
City : CENTENNIAL
State : CO
Zip : 80112-2025
Country : US
Telephone Number : 303-721-9984
Fax Number :
Provider Business Practice Location Address
First Line : 7030 S YOSEMITE ST
Second Line :
City : CENTENNIAL
State : CO
Zip : 80112-2016
Country : US
Telephone Number : 303-721-9984
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2019
Last Update Date : 07/16/2019

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