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Individual
MYRA MIKE
Active
Individual
MYRA MIKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R49291
NM
363LP0200X
Pediatric Nurse Practitioner
Primary
CNP-03332
NM
Other
Enumeration date
02/11/2015
Last updated
04/24/2018
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