Individual
MIRANDA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
4001 W MCNICHOLS RD, DETROIT, MI 48221-3038
(313) 993-1245
Mailing address
11429 ASPEN DR, PLYMOUTH, MI 48170-4583
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704364557
MI
Other
Enumeration date
04/20/2026
Last updated
04/20/2026
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