Provider Demographics
NPI:1487616777
Name:PLASS, MIRIAM ELON (RN)
Entity type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:ELON
Last Name:PLASS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:MIRIAM
Other - Middle Name:ELON
Other - Last Name:RAINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:36851 HAYWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-1630
Mailing Address - Country:US
Mailing Address - Phone:760-380-6027
Mailing Address - Fax:760-380-5861
Practice Address - Street 1:USA- MEDDAC ATTN: MCXK-PM-CHN
Practice Address - Street 2:BOX 105109
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310
Practice Address - Country:US
Practice Address - Phone:760-380-6027
Practice Address - Fax:760-380-5861
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA654477163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse