Provider Demographics
NPI:1538677208
Name:MIRANDA, CARMEN ELENA (CNP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:ELENA
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1340 BELMONT AVE STE 2200
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1131
Mailing Address - Country:US
Mailing Address - Phone:307-467-4003
Mailing Address - Fax:330-746-7436
Practice Address - Street 1:1340 BELMONT AVE STE 2200
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504
Practice Address - Country:US
Practice Address - Phone:307-467-4003
Practice Address - Fax:330-746-7436
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.022167363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner