Provider Demographics
NPI:1831923200
Name:MAYER, MIRANDA MARIE
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:MARIE
Last Name:MAYER
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 1:7403 N 91ST AVE APT 135
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-1210
Mailing Address - Country:US
Mailing Address - Phone:928-266-5439
Mailing Address - Fax:
Practice Address - Street 1:7403 N 91ST AVE APT 135
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-1210
Practice Address - Country:US
Practice Address - Phone:928-266-5439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ237867163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn