Provider Demographics
NPI:1790439669
Name:TURNER, MIRANDA (RN)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:TURNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:HAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W227N2590 MEADOWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-8840
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:W227N2590 MEADOWOOD LN
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-8840
Practice Address - Country:US
Practice Address - Phone:262-408-8798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI228325-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse