Provider Demographics
NPI:1093535056
Name:MIRON, CHRISTA (LPN)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:MIRON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 LUDINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-3542
Mailing Address - Country:US
Mailing Address - Phone:906-786-7212
Mailing Address - Fax:906-786-0676
Practice Address - Street 1:1100 LUDINGTON ST
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-3542
Practice Address - Country:US
Practice Address - Phone:906-786-7212
Practice Address - Fax:906-786-0676
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703110711164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse