Provider Demographics
NPI:1720893738
Name:GAEDEKE, MIRANDA
Entity type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:
Last Name:GAEDEKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E DEVISION ST
Mailing Address - Street 2:APT. 24
Mailing Address - City:CLAY CENTER
Mailing Address - State:NE
Mailing Address - Zip Code:68933-9998
Mailing Address - Country:US
Mailing Address - Phone:402-762-5984
Mailing Address - Fax:
Practice Address - Street 1:114 E DIVISION ST
Practice Address - Street 2:APT. 24
Practice Address - City:CLAY CENTER
Practice Address - State:NE
Practice Address - Zip Code:68933-9998
Practice Address - Country:US
Practice Address - Phone:402-762-5984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant