Provider Demographics
NPI:1609656073
Name:MIRANDA, SAVONNA LYNN (THW)
Entity Type:Individual
Prefix:
First Name:SAVONNA
Middle Name:LYNN
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:THW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 COBURG RD STE C
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6114
Mailing Address - Country:US
Mailing Address - Phone:541-505-9190
Mailing Address - Fax:541-505-9264
Practice Address - Street 1:315 COBURG RD STE C
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6114
Practice Address - Country:US
Practice Address - Phone:541-505-9190
Practice Address - Fax:541-505-9264
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000109508175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist