Individual
MIRANDA MATHISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2301 25TH ST S, FARGO, ND 58103-6104
(701) 237-9712
(701) 237-0922
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAC0578
ND
Other
Enumeration date
10/07/2014
Last updated
02/21/2022
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