Provider Demographics
NPI:1013651702
Name:MIRANTE, AILEEN M (OWNER)
Entity Type:Individual
Prefix:MS
First Name:AILEEN
Middle Name:M
Last Name:MIRANTE
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 185TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-2462
Mailing Address - Country:US
Mailing Address - Phone:206-403-0077
Mailing Address - Fax:
Practice Address - Street 1:8320 185TH STREET CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-2462
Practice Address - Country:US
Practice Address - Phone:206-403-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.61266062253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care