Individual
MARYANNE S MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
377 JERSEY AVE, JERSEY CITY, NJ 07302-4393
(201) 499-3897
Mailing address
436 FAIRMOUNT AVE, JERSEY CITY, NJ 07306-5910
(201) 616-2379
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
26NR14519200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35-2321534
LUTHERAN SENIOR LIFE AT JERSEY CITY
NJ
Enumeration date
02/18/2013
Last updated
02/18/2013
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