Provider Demographics
NPI:1770089187
Name:BOYTE, MIRANDA SUE (RN)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:SUE
Last Name:BOYTE
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 1:2727 BENS BRAND DRIVE
Mailing Address - Street 2:APT 804
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339
Mailing Address - Country:US
Mailing Address - Phone:601-320-4186
Mailing Address - Fax:
Practice Address - Street 1:2727 BENS BRAND DRIVE
Practice Address - Street 2:APT 804
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339
Practice Address - Country:US
Practice Address - Phone:601-320-4186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS899388163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse