| NPI | 1548246630 |
|---|---|
| Former Name | MIRANDA LYNN MIKKELSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ND R28268) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP113329) |
| 363LF0000X Nurse Practitioner, Family (Licence: ND R28268) | |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2022-07-21 |