Individual
COREY MIRACLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
950 W WOOSTER ST, BOWLING GREEN, OH 43402-2699
(419) 354-8900
Mailing address
950 W WOOSTER ST, BOWLING GREEN, OH 43402-2699
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0037699
OH
Other
Enumeration date
10/09/2024
Last updated
10/09/2024
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