Individual
YAZMIN FUENTES MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
855 N WESTHAVEN DR, OSHKOSH, WI 54904-7668
(920) 303-8700
Mailing address
3860 MONROE RD, DE PERE, WI 54115-8399
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
50503
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00733586
MEDICARE RAILROAD
MN
Enumeration date
04/06/2007
Last updated
09/28/2018
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