Provider Demographics
NPI:1922842830
Name:NEU, MIRANDA SUZANNE (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:SUZANNE
Last Name:NEU
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5839 W 94TH AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-6515
Mailing Address - Country:US
Mailing Address - Phone:402-889-1237
Mailing Address - Fax:
Practice Address - Street 1:12600 W COLFAX AVE STE B200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-3736
Practice Address - Country:US
Practice Address - Phone:303-933-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0999862-NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care