Provider Demographics
NPI:1386335156
Name:ULMER, MIRRA JEAN (CNP)
Entity type:Individual
Prefix:MRS
First Name:MIRRA
Middle Name:JEAN
Last Name:ULMER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 HARRIS HAWK LN
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-8515
Mailing Address - Country:US
Mailing Address - Phone:419-481-2797
Mailing Address - Fax:
Practice Address - Street 1:5609 HARRIS HAWK LN
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-8515
Practice Address - Country:US
Practice Address - Phone:419-481-2797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPARN.CNP.0030436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty