Provider Demographics
NPI:1306557145
Name:FOREMAN, MIRANDA GAIL
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:GAIL
Last Name:FOREMAN
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 1:7122 S SHERIDAN RD STE 21040
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-2774
Mailing Address - Country:US
Mailing Address - Phone:405-962-9137
Mailing Address - Fax:
Practice Address - Street 1:7122 S SHERIDAN RD STE 21040
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-2774
Practice Address - Country:US
Practice Address - Phone:405-962-9137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility