Provider Demographics
NPI:1316579246
Name:HUEPERS, MIRANDA (ND, RN)
Entity Type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:
Last Name:HUEPERS
Suffix:
Gender:F
Credentials:ND, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 EL GUSTO AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-4427
Mailing Address - Country:US
Mailing Address - Phone:907-651-2414
Mailing Address - Fax:
Practice Address - Street 1:605 EL GUSTO AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-4427
Practice Address - Country:US
Practice Address - Phone:907-651-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-08
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV869707163W00000X
TX1104634163W00000X
AK206552163W00000X
MTAHC-NAT-LIC-2121175F00000X
VT099.0134097175F00000X
AK163322175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty