Provider Demographics
NPI:1407339450
Name:MIRANDA, VERONICA S (RN)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:S
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N WHITE SANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6246
Mailing Address - Country:US
Mailing Address - Phone:575-437-3505
Mailing Address - Fax:575-439-4494
Practice Address - Street 1:1900 N WHITE SANDS BLVD
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6246
Practice Address - Country:US
Practice Address - Phone:575-437-3505
Practice Address - Fax:575-439-4494
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-83365163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool