Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 6830-33 | WI |
N | 363LA2200X | Nurse Practitioner - Adult Health | 6830-33 | WI |
NPI | 1013377969 |
---|---|
Provider Name | Miranda Marie Hintz |
First Address | Green Bay, WI 54305-2487 |
Second Address | Green Bay, WI 54301-3505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2016 |
Last Update Date | 16/09/2019 |