Individual
JACQUELINE MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
520 NORTH DR, UPPER SANDUSKY, OH 43351-9033
(419) 294-0321
Mailing address
520 NORTH DR, UPPER SANDUSKY, OH 43351-9033
(419) 294-0321
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
—
—
376J00000X
Homemaker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0248420
ODJFS MEDICAID PROVIDER NUMBER
OH
Enumeration date
11/14/2020
Last updated
11/14/2020
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