Provider Demographics
NPI:1093029076
Name:STANLEY, MIRANDA DAWN (FNP)
Entity Type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:DAWN
Last Name:STANLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2331 TYLER PKWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0871
Mailing Address - Country:US
Mailing Address - Phone:701-255-4000
Mailing Address - Fax:701-255-1992
Practice Address - Street 1:2331 TYLER PKWY
Practice Address - Street 2:SUITE 4
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0871
Practice Address - Country:US
Practice Address - Phone:701-255-4000
Practice Address - Fax:701-255-1992
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NDR29452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily