Provider Demographics
NPI:1912270927
Name:WHITE, MIRANDA A
Entity type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:A
Last Name:WHITE
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:P.O. BOX 528
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559
Mailing Address - Country:US
Mailing Address - Phone:907-543-6229
Mailing Address - Fax:907-543-6393
Practice Address - Street 1:100 NIGHTMUTE CLINIC STREET
Practice Address - Street 2:
Practice Address - City:NIGHTMUTE
Practice Address - State:AK
Practice Address - Zip Code:99690-9001
Practice Address - Country:US
Practice Address - Phone:907-647-6312
Practice Address - Fax:907-647-6014
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other