Provider Demographics
NPI:1568851509
Name:TOWNSEND, MIRANDA LEE (ARNP)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:LEE
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:LEE
Other - Last Name:HENNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:302 E PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1433
Mailing Address - Country:US
Mailing Address - Phone:509-606-0708
Mailing Address - Fax:509-606-1514
Practice Address - Street 1:302 E PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1433
Practice Address - Country:US
Practice Address - Phone:509-606-0708
Practice Address - Fax:509-606-1514
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60494711363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2014012981OtherANCC