Provider Demographics
NPI:1659002145
Name:MIRANDA, CRISTOPHER MANGALINDAN (ARNP)
Entity Type:Individual
Prefix:MR
First Name:CRISTOPHER
Middle Name:MANGALINDAN
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11802 TRAILWOOD PL NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8618
Mailing Address - Country:US
Mailing Address - Phone:360-689-1706
Mailing Address - Fax:
Practice Address - Street 1:2456 GLENN CT SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3030
Practice Address - Country:US
Practice Address - Phone:360-689-1706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAP61316746363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health