MEDICARE: SANTANA PATRICIA MIRANDA RN L#0001310361

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	163W00000X	Registered Nurse	0001310361	VA

General Provider Information

NPI Number	:	1881442002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANTANA PATRICIA MIRANDA RN L#0001310361

Provider Business Mailing Address
First Line	:	8312 SHADY GROVE CIR
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20110-4680
Country	:	US
Telephone Number	:	571-250-9354
Fax Number	:

Provider Business Practice Location Address
First Line	:	18318 WOODLAND DR
Second Line	:
City	:	TRIANGLE
State	:	VA
Zip	:	22172-1312
Country	:	US
Telephone Number	:	571-250-9354
Fax Number	:

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

Provider Enumeration Date	:	05/13/2024
Last Update Date	:	06/08/2024

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