Individual
MIRANDA NICOLE MCWILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
507 BROWN AVE, ALAMOSA, CO 81101-2308
(505) 620-2992
Mailing address
507 BROWN AVE, ALAMOSA, CO 81101-2308
(505) 620-2992
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000011978
BOARD OF CERTIFICATION
—
Enumeration date
11/29/2016
Last updated
11/29/2016
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