Provider Demographics
NPI:1174729792
Name:MIRANDA, IRENE LAPUZ (RN)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:LAPUZ
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 APHRODITE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515
Mailing Address - Country:US
Mailing Address - Phone:907-336-1296
Mailing Address - Fax:907-336-1298
Practice Address - Street 1:9401 APHRODITE DRIVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515
Practice Address - Country:US
Practice Address - Phone:907-336-1296
Practice Address - Fax:907-336-1298
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK26208163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL 3873OtherFIRST HEALTH