Provider Demographics
NPI:1326672676
Name:ISRAEL, MIRACLE
Entity Type:Individual
Prefix:
First Name:MIRACLE
Middle Name:
Last Name:ISRAEL
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 1:19116 33RD AVE W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4706
Mailing Address - Country:US
Mailing Address - Phone:425-712-7900
Mailing Address - Fax:425-712-7905
Practice Address - Street 1:19116 33RD AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4706
Practice Address - Country:US
Practice Address - Phone:425-712-7900
Practice Address - Fax:425-712-7905
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60490415163W00000X
WAAP61081985363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse