Provider Demographics
NPI:1710031489
Name:HARDING, MIRANDA MELISSA (LMP)
Entity Type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:MELISSA
Last Name:HARDING
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14622
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98511-4622
Mailing Address - Country:US
Mailing Address - Phone:360-259-1429
Mailing Address - Fax:
Practice Address - Street 1:915 TROSPER RD SW STE 102
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-6972
Practice Address - Country:US
Practice Address - Phone:360-339-6425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015118174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist