Provider Demographics
NPI:1710564687
Name:BRESHEARS, MIRANDA MARIE (RN)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:MARIE
Last Name:BRESHEARS
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 1:8001 SILVA AVE SE
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-9656
Mailing Address - Country:US
Mailing Address - Phone:425-301-8515
Mailing Address - Fax:
Practice Address - Street 1:8001 SILVA AVE SE
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-9656
Practice Address - Country:US
Practice Address - Phone:425-301-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60924239163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics