Individual
GRETA LOUISE MIRACLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
16703 SE MCGILLIVRAY BLVD, VANCOUVER, WA 98683-4300
(360) 566-4840
(360) 566-4841
Mailing address
405 NE 80TH AVE, PORTLAND, OR 97213-7019
(206) 313-1113
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
60058267
WA
Other
Enumeration date
11/24/2008
Last updated
11/24/2008
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