Individual
MRS. JOANNE LEE MIRACLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP-C; GNP-C
Contact information
Practice address
4560 SE INTERNATIONAL WAY STE 100, MILWAUKIE, OR 97222-4628
(971) 206-5179
(503) 905-0495
Mailing address
4560 SE INTERNATIONAL WAY STE 100, MILWAUKIE, OR 97222-4628
(971) 206-5179
(503) 905-0495
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
200050105NP
OR
363LG0600X
Gerontology Nurse Practitioner
200050105NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113099
—
OR
Enumeration date
06/18/2006
Last updated
08/10/2020
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