Provider Demographics
NPI:1467840280
Name:CHENEY, MIRANDA LYNNE (CRNP)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:LYNNE
Last Name:CHENEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:LYNNE
Other - Last Name:WINTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-5057
Mailing Address - Country:US
Mailing Address - Phone:205-344-9028
Mailing Address - Fax:205-344-9031
Practice Address - Street 1:3611 WINDY RDG
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-3676
Practice Address - Country:US
Practice Address - Phone:205-344-9028
Practice Address - Fax:205-344-9031
Is Sole Proprietor?:No
Enumeration Date:2014-12-31
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-126137163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-126137OtherALABAMA BOARD OF NURSING
AL2013018826OtherAMERICAN NURSES CREDENTIALING CENTER