Individual
MRS. MIRANDA JO DAVID
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
11505 W. HWY. 24, DIVIDE, CO 80814
(719) 687-6416
Mailing address
PO BOX 482, DIVIDE, CO 80814-0482
(719) 687-6494
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
128371
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
51032732
—
CO
Enumeration date
11/08/2006
Last updated
07/09/2007
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