Provider Demographics
NPI:1952718801
Name:HOWARD, MIRANDA ELAINE (LPN)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:ELAINE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 HARRIS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-2428
Mailing Address - Country:US
Mailing Address - Phone:740-616-7680
Mailing Address - Fax:
Practice Address - Street 1:717 S 30TH ST
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-1294
Practice Address - Country:US
Practice Address - Phone:740-522-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN137441MIV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse