Provider Demographics
NPI:1992953244
Name:DELEEL, MIRANDA LEE (LPN)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:LEE
Last Name:DELEEL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867 OLD MARKET RD
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3247
Mailing Address - Country:US
Mailing Address - Phone:315-265-4332
Mailing Address - Fax:
Practice Address - Street 1:867 OLD MARKET RD
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3247
Practice Address - Country:US
Practice Address - Phone:315-265-4332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181595-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse