Individual
MIRANDA FEZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
3517 NW CAMAS MEADOWS DR STE 210, CAMAS, WA 98607-6602
(360) 345-3175
Mailing address
3517 NW CAMAS MEADOWS DR STE 210, CAMAS, WA 98607-6602
(360) 345-3175
(360) 230-4780
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60697855
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467901074
—
WA
01
—
P01724334
RR MEDICARE WVH
WA
Enumeration date
09/23/2016
Last updated
04/18/2024
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