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Individual
MS. MIRANDA M MACKO
Active
Individual
MS. MIRANDA M MACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-C
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704367492
MI
363LA2200X
Adult Health Nurse Practitioner
4704367492
MI
363LG0600X
Gerontology Nurse Practitioner
4704367492
MI
363LP2300X
Primary Care Nurse Practitioner
4704367492
MI
Other
Enumeration date
04/08/2024
Last updated
12/15/2024
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