Provider Demographics
NPI:1376891911
Name:SOCIA, MIRANDA BETH (CNA/CNA2)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:BETH
Last Name:SOCIA
Suffix:
Gender:F
Credentials:CNA/CNA2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21602 SE ALDER ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-2435
Mailing Address - Country:US
Mailing Address - Phone:541-870-0489
Mailing Address - Fax:
Practice Address - Street 1:21602 SE ALDER ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-2435
Practice Address - Country:US
Practice Address - Phone:541-870-0489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201011355CNA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide