Individual
MIRANDA PORTWINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2345 DOUGHERTY FERRY RD, SAINT LOUIS, MO 63122-3313
(314) 485-1101
Mailing address
PO BOX 14470, SAINT LOUIS, MO 63178-4470
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2021020908
MO
Other
Enumeration date
06/18/2021
Last updated
06/18/2021
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