Basic Information
| Provider Information | |||||||||
| NPI: | 1912270927 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | MIRANDA | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 528 | ||||||||
| Address2: | |||||||||
| City: | BETHEL | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075436229 | ||||||||
| FaxNumber: | 9075436393 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 NIGHTMUTE CLINIC STREET | ||||||||
| Address2: | |||||||||
| City: | NIGHTMUTE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996909001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9076476312 | ||||||||
| FaxNumber: | 9076476014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2012 | ||||||||
| LastUpdateDate: | 02/22/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.