Provider Demographics
NPI:1316283179
Name:DEERING, MIRANDA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:MARIE
Last Name:DEERING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 MYRTLE ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-4602
Mailing Address - Country:US
Mailing Address - Phone:814-454-8185
Mailing Address - Fax:814-454-3894
Practice Address - Street 1:2315 MYRTLE ST
Practice Address - Street 2:SUITE 220
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-4602
Practice Address - Country:US
Practice Address - Phone:814-454-8185
Practice Address - Fax:814-454-3894
Is Sole Proprietor?:No
Enumeration Date:2012-12-26
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA055173363A00000X
PAOA002844363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant