Dethier, Miranda R

Dethier, Miranda R is an individual health care provider with primary practice located at 840 W Racine St , Jefferson WI 53549-1053. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Dethier, Miranda R can be contacted via phone (920) 674-6000.

Contact Information

Primary practice address
840 W Racine St Jefferson WI 53549-1053
Phone: (920) 674-6000
Fax: (920) 674-3034
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 2758-23 Wisconsin

Profile Details

NPI number 1760770960
LBN Legal business name Dethier, Miranda R
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 21st, 2011
Last updated May 3rd, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760770960 NPPES
Wisconsin MEDICAID 1760770960

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