Provider Demographics
NPI:1194611434
Name:RULAND, MIRANDA SHANK (PA)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:SHANK
Last Name:RULAND
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 N BERETTA CT
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-7505
Mailing Address - Country:US
Mailing Address - Phone:918-504-8007
Mailing Address - Fax:
Practice Address - Street 1:1922 N BERETTA CT
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-7505
Practice Address - Country:US
Practice Address - Phone:918-504-8007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant