Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | R36695 | ND |
NPI | 1013673672 |
---|---|
Provider Name | Miranda Schaan |
First Address | Fargo, ND 58103-7892 |
Second Address | Fargo, ND 58102-4421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2021 |
Last Update Date | 09/11/2021 |