Provider Demographics
NPI:1366719874
Name:AZBILL, MIRANDA LEAH (BSW)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:LEAH
Last Name:AZBILL
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:MS
Other - First Name:MIRANDA
Other - Middle Name:LEAH
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6166 MEADOW VIEW LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-1126
Mailing Address - Country:US
Mailing Address - Phone:702-772-8582
Mailing Address - Fax:
Practice Address - Street 1:2770 S MARYLAND PKWY
Practice Address - Street 2:211
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1554
Practice Address - Country:US
Practice Address - Phone:702-530-6117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner