Provider Demographics
NPI:1124073002
Name:MIRANDA, AMY MICHELLE (CRNA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MICHELLE
Other - Last Name:VOLKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1861 POWDER MILL RD
Mailing Address - Street 2:ATTN MSO
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-4723
Mailing Address - Country:US
Mailing Address - Phone:717-718-2041
Mailing Address - Fax:717-747-2102
Practice Address - Street 1:1861 POWDER MILL RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4723
Practice Address - Country:US
Practice Address - Phone:717-718-2000
Practice Address - Fax:717-718-3460
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR134791367500000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
053380OtherNATIONAL CRNA
MDM653066603025OtherLICENSE