MIRANDA PORTWINE

SAINT LOUIS, MO
NPI1346819968
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy367500000X Nurse Anesthetist, Certified Registered
(Licence: MO  2021020908)
Enumeration Date2021-06-18
Last Update Date2021-06-18
Business Address
MIRANDA PORTWINE CRNA
2345 DOUGHERTY FERRY RD
SAINT LOUIS, MO 63122-3313
Phone number: 314-485-1101
Mailing Address
MIRANDA PORTWINE CRNA
PO BOX 14470
SAINT LOUIS, MO 63178-4470
Phone number:
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