Provider Demographics
NPI:1225602378
Name:KAMRANIAN, MICHAELA
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:KAMRANIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:SHELDON
Mailing Address - State:ND
Mailing Address - Zip Code:58068-4126
Mailing Address - Country:US
Mailing Address - Phone:701-936-0443
Mailing Address - Fax:
Practice Address - Street 1:3233 15TH AVE SW APT A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8401
Practice Address - Country:US
Practice Address - Phone:701-293-3341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant