Provider Demographics
NPI:1952126401
Name:FARMER, MIRANDA CLARE (RN, BSN, IBCLC, CBS)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:CLARE
Last Name:FARMER
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC, CBS
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:CLARE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13201 LAKE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-9100
Mailing Address - Country:US
Mailing Address - Phone:916-218-8780
Mailing Address - Fax:
Practice Address - Street 1:13201 LAKE VALLEY DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-9100
Practice Address - Country:US
Practice Address - Phone:916-218-8780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95131875163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant