Individual
MRS. MIRANDA ELIZABETH BLAJSZCZAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2340 S COFFMAN AVE, CASPER, WY 82604-3521
(307) 265-6698
Mailing address
2340 S COFFMAN AVE, CASPER, WY 82604-3521
(307) 265-6698
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
22824
WY
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
06/01/2010
Last updated
05/31/2011
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