Provider Demographics
NPI:1932730447
Name:MIRANOVA HEALTH PLLC
Entity Type:Organization
Organization Name:MIRANOVA HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:NANCY
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-240-4258
Mailing Address - Street 1:PO BOX 21249
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98111-3249
Mailing Address - Country:US
Mailing Address - Phone:206-902-4582
Mailing Address - Fax:206-902-4159
Practice Address - Street 1:715 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2066
Practice Address - Country:US
Practice Address - Phone:206-902-4582
Practice Address - Fax:206-902-4159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty