Provider Demographics
NPI:1720293368
Name:REEDY, MIRANDA A (RN)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:A
Last Name:REEDY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:R
Other - Last Name:AUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3355 GEORGE BUSBEE PKWY NW APT 502
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6829
Mailing Address - Country:US
Mailing Address - Phone:352-362-8847
Mailing Address - Fax:
Practice Address - Street 1:424 SAVANNAH RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958
Practice Address - Country:US
Practice Address - Phone:302-645-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN267385163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse