Provider Demographics
NPI:1982424115
Name:KOESTER, MIRANDA (RN, BSN, IBCLC)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:KOESTER
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20630 COUNTY ROAD 48
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-9606
Mailing Address - Country:US
Mailing Address - Phone:970-580-2192
Mailing Address - Fax:
Practice Address - Street 1:20630 COUNTY ROAD 48
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-9606
Practice Address - Country:US
Practice Address - Phone:970-580-2192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COL-315008163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant