Individual
MIRANDA LOUISE FARIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
11188 N 550 E, DEMOTTE, IN 46310-8947
(219) 964-5312
Mailing address
11188 N 550 E, DEMOTTE, IN 46310-8947
(219) 964-5312
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F07191270
IN
Other
Enumeration date
02/12/2020
Last updated
02/12/2020
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