Provider Demographics
NPI:1588324941
Name:VECHINI MIRANDA, JESSICA (ND, MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:VECHINI MIRANDA
Suffix:
Gender:F
Credentials:ND, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5563 36TH AVE S UNIT E
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-5236
Mailing Address - Country:US
Mailing Address - Phone:939-255-2451
Mailing Address - Fax:
Practice Address - Street 1:1506 30TH AVE S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5195
Practice Address - Country:US
Practice Address - Phone:218-284-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1165-PA363AM0700X
MN1151175F00000X
PR81171100000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No171100000XOther Service ProvidersAcupuncturist