MEDICARE: MRS. MIRANDA YVONNE BROWN APRN

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	363L00000X	Nurse Practitioner	53-75441-121	KS
2	363LP2300X	Primary Care Nurse Practitioner	53-75441	KS
3	363L00000X	Nurse Practitioner	53-75441	KS

General Provider Information

NPI Number	:	1932482809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MIRANDA YVONNE BROWN APRN

Provider Business Mailing Address
First Line	:	1410 E IRON AVE STE 1
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67401-3285
Country	:	US
Telephone Number	:	316-706-1302
Fax Number	:	785-826-1660

Provider Business Practice Location Address
First Line	:	1410 E IRON AVE STE 1
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67401-3285
Country	:	US
Telephone Number	:	316-706-1302
Fax Number	:	785-826-1660

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

Provider Enumeration Date	:	09/27/2011
Last Update Date	:	06/10/2020

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