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NPI Code Detail

MEDICARE: DR. SARA DIANA MIRANDA DNP

MEDICARE: DR. SARA DIANA MIRANDA DNP
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 Practitioner277000406IL

General Provider Information

NPI Number : 1841690328
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SARA DIANA MIRANDA DNP
Provider Business Mailing Address
First Line : 14 LAKE ST
Second Line :
City : OAK PARK
State : IL
Zip : 60302-2606
Country : US
Telephone Number : 708-383-0113
Fax Number : 708-383-0226
Provider Business Practice Location Address
First Line : 14 LAKE ST
Second Line :
City : OAK PARK
State : IL
Zip : 60302-2606
Country : US
Telephone Number : 708-383-0113
Fax Number : 708-383-0226
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2014
Last Update Date : 05/27/2026

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