Provider Demographics
NPI:1811707508
Name:HADDEN, MIRANDA MAE
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:MAE
Last Name:HADDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-9015
Mailing Address - Country:US
Mailing Address - Phone:712-524-4088
Mailing Address - Fax:
Practice Address - Street 1:106 BLUFF ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9015
Practice Address - Country:US
Practice Address - Phone:712-524-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide