Provider Demographics
NPI:1801957105
Name:HOWARD, MYRA T (RN-C,FNP)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:T
Last Name:HOWARD
Suffix:
Gender:F
Credentials:RN-C,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 W HIGHWAY 246
Mailing Address - Street 2:
Mailing Address - City:BUELLTON
Mailing Address - State:CA
Mailing Address - Zip Code:93427-9459
Mailing Address - Country:US
Mailing Address - Phone:805-686-8555
Mailing Address - Fax:805-686-8556
Practice Address - Street 1:195 W HIGHWAY 246
Practice Address - Street 2:
Practice Address - City:BUELLTON
Practice Address - State:CA
Practice Address - Zip Code:93427-9459
Practice Address - Country:US
Practice Address - Phone:805-686-8555
Practice Address - Fax:805-686-8556
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN306265363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily