Provider Demographics
NPI:1780429647
Name:ULANOWSKI, MIRANDA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:
Last Name:ULANOWSKI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 KITTRELL ST
Mailing Address - Street 2:
Mailing Address - City:HOHENWALD
Mailing Address - State:TN
Mailing Address - Zip Code:38462-1363
Mailing Address - Country:US
Mailing Address - Phone:931-796-1818
Mailing Address - Fax:
Practice Address - Street 1:110 KITTRELL ST
Practice Address - Street 2:
Practice Address - City:HOHENWALD
Practice Address - State:TN
Practice Address - Zip Code:38462-1363
Practice Address - Country:US
Practice Address - Phone:931-796-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily