| NPI | 1538789581 |
|---|---|
| Former Name | MIRANDA NICOLE MANN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10016673) |
| Enumeration Date | 2020-04-20 |
| Last Update Date | 2026-07-30 |