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Individual

MS. MIRANDA JANE SMITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
NP-C

Contact information

Practice address
3510 MONTLIMAR PLAZA DR STE 100, MOBILE, AL 36609-1746
(251) 635-4541
Mailing address
5458 COLONY TRACE CT, SATSUMA, AL 36572-2409
(251) 490-2026

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1-129637
AL
363LA2200X
Adult Health Nurse Practitioner
Primary
1-129637
AL

Other

Enumeration date
08/16/2017
Last updated
11/20/2017
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