Provider Demographics
NPI:1902234636
Name:WARD, MIRANDA LOUISE (LPN)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:LOUISE
Last Name:WARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 SPRINGFIELD RD
Mailing Address - Street 2:APT B
Mailing Address - City:WILMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:12997-2300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:849 SPRINGFIELD RD
Practice Address - Street 2:APT B
Practice Address - City:WILMINGTON
Practice Address - State:NY
Practice Address - Zip Code:12997-2300
Practice Address - Country:US
Practice Address - Phone:301-606-6689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315046164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse