Provider Demographics
NPI:1316766074
Name:ESQUIVEL, MIRIAM LILY (RN)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:LILY
Last Name:ESQUIVEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345-1549
Mailing Address - Country:US
Mailing Address - Phone:616-685-1300
Mailing Address - Fax:616-887-5989
Practice Address - Street 1:475 S STATE ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MI
Practice Address - Zip Code:49345-1549
Practice Address - Country:US
Practice Address - Phone:616-685-1300
Practice Address - Fax:616-887-5989
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704275230163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse