Provider Demographics
NPI:1134092109
Name:CHASE, MIRACLE (RN)
Entity type:Individual
Prefix:
First Name:MIRACLE
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 OHIO DR APT 4065
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6574
Mailing Address - Country:US
Mailing Address - Phone:501-412-3588
Mailing Address - Fax:
Practice Address - Street 1:3033 OHIO DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-6292
Practice Address - Country:US
Practice Address - Phone:501-412-3588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR228767163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse