Provider Demographics
NPI:1427764869
Name:WILLIAMS, MIRANDA LUANN (PA)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:LUANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2273 ST CLAIRE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-4519
Mailing Address - Country:US
Mailing Address - Phone:720-325-4781
Mailing Address - Fax:
Practice Address - Street 1:1650 COCHRANE CIR UNIT MEDDAC
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4604
Practice Address - Country:US
Practice Address - Phone:720-325-4781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2024-01-25
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant