Provider Demographics
NPI:1316579246
Name:HUEPERS, MIRANDA (ND, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:
Last Name:HUEPERS
Suffix:
Gender:F
Credentials:ND, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 EL GUSTO AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-4427
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2225 E FLAMINGO RD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5127
Practice Address - Country:US
Practice Address - Phone:725-206-5508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-08
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1104634363LF0000X
NV869707363LF0000X, 363LF0000X, 363LF0000X
MTAHC-NAT-LIC-2121175F00000X
AK163322175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Single Specialty