Provider Demographics
NPI:1023122397
Name:MIRON, MARK E (RN)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:E
Last Name:MIRON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-2475
Mailing Address - Country:US
Mailing Address - Phone:906-482-9404
Mailing Address - Fax:906-483-0269
Practice Address - Street 1:901 MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-2475
Practice Address - Country:US
Practice Address - Phone:906-482-9404
Practice Address - Fax:906-483-0269
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704196786163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse