Provider Demographics
NPI:1295920072
Name:COLLINS, MIRANDA LAURA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:LAURA
Last Name:COLLINS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:9717 SLALOM RUN DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1106
Mailing Address - Country:US
Mailing Address - Phone:410-922-3952
Mailing Address - Fax:410-655-7239
Practice Address - Street 1:1238 PUTTY HILL AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5844
Practice Address - Country:US
Practice Address - Phone:410-823-4423
Practice Address - Fax:410-823-5180
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR107522363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily