Provider Demographics
NPI:1174957302
Name:TURNBLACER, MIRANDA JB (RN, CRNP)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:JB
Last Name:TURNBLACER
Suffix:
Gender:F
Credentials:RN, CRNP
Other - Prefix:
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Mailing Address - Street 1:2104 PINEY BRANCH CIR
Mailing Address - Street 2:APT 603
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1833
Mailing Address - Country:US
Mailing Address - Phone:402-618-9707
Mailing Address - Fax:
Practice Address - Street 1:319 E ANTIETAM ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5701
Practice Address - Country:US
Practice Address - Phone:301-790-3620
Practice Address - Fax:301-797-2863
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR193544363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics