Provider Demographics
NPI:1407807720
Name:MIRANDA, CHERYL A (MS)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 NW 115TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-3664
Mailing Address - Country:US
Mailing Address - Phone:360-571-8081
Mailing Address - Fax:
Practice Address - Street 1:3325 N INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1020
Practice Address - Country:US
Practice Address - Phone:503-331-6326
Practice Address - Fax:503-331-6320
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS