Miranda Dawn Antonio, A.A.
Individual provider Active NPI Counselor · Tularosa, NM
NPI 1104008432 · NPPES record last updated Nov 28, 2007
Key facts
- NPI
- 1104008432
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 253 Pecos Rd
Tularosa, NM 88352-9666 - Phone
- (505) 379-4838
- NPI assigned
- Nov 28, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Associate of Arts
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
253 Pecos Rd
Tularosa, NM 88352-9666
Mailing address
253 Pecos Rd
Tularosa, NM 88352-9666
Phone (505) 379-4838
Other providers in Tularosa, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 28, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.