Individual
MIRANDA LYNN WARAXA
Active
Individual
MIRANDA LYNN WARAXA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
170741-30
WI
363LA2200X
Adult Health Nurse Practitioner
Primary
170741
WI
363LG0600X
Gerontology Nurse Practitioner
170741
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
170741-30
WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES
WI
05
—
1902464233
—
WI
Enumeration date
06/02/2019
Last updated
06/27/2019
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