Provider Demographics
NPI:1710564612
Name:REED, MIRANDA (RN)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2174 LAKEVIEW DR APT 433
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-6773
Mailing Address - Country:US
Mailing Address - Phone:989-274-4224
Mailing Address - Fax:
Practice Address - Street 1:2174 LAKEVIEW DR APT 433
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-6773
Practice Address - Country:US
Practice Address - Phone:989-274-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704371468163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse