Individual
SUSANNA MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, APRN, AGNP-C
Contact information
Practice address
676 N SAINT CLAIR ST FL 19, CHICAGO, IL 60611-2927
(312) 695-8900
(312) 695-7752
Mailing address
676 N SAINT CLAIR ST FL 19, CHICAGO, IL 60611-2927
(312) 695-8900
(312) 695-7752
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041-332458
IL
363L00000X
Nurse Practitioner
Primary
209017775
IL
363LG0600X
Gerontology Nurse Practitioner
209-017775
IL
Other
Enumeration date
07/19/2006
Last updated
07/02/2024
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