Individual
MIRANDA COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
215 5TH ST, MARIETTA, OH 45750-4033
(740) 376-4477
Mailing address
215 5TH ST, MARIETTA, OH 45750-4033
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
519
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
WV
Enumeration date
12/04/2006
Last updated
08/02/2024
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