Provider Demographics
NPI:1851989586
Name:WHITE, MIRANDA R (MS)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:R
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS
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 126
Mailing Address - Street 2:
Mailing Address - City:JOY
Mailing Address - State:IL
Mailing Address - Zip Code:61260-0126
Mailing Address - Country:US
Mailing Address - Phone:309-507-2292
Mailing Address - Fax:
Practice Address - Street 1:1616 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-3453
Practice Address - Country:US
Practice Address - Phone:309-779-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker