Provider Demographics
NPI:1669289476
Name:MIRADOR, ANGELA LYNN (RN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:MIRADOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7012 OSPREY CIR
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-8852
Mailing Address - Country:US
Mailing Address - Phone:360-509-1547
Mailing Address - Fax:
Practice Address - Street 1:10049 KITSAP MALL BLVD NW STE 201
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8901
Practice Address - Country:US
Practice Address - Phone:360-373-6966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61173998163WM0705X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical