Provider Demographics
NPI:1699881797
Name:BACHMAN, MIRANDA (LMP)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:
Last Name:BACHMAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:7101 W HOOD PL
Mailing Address - Street 2:SUITE102
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6719
Mailing Address - Country:US
Mailing Address - Phone:509-374-4729
Mailing Address - Fax:509-374-3873
Practice Address - Street 1:7101 W HOOD PL
Practice Address - Street 2:SUITE102
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6714
Practice Address - Country:US
Practice Address - Phone:509-374-4729
Practice Address - Fax:509-374-3873
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010231174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist