Miranda Renee Wilson, FNP

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

95019330 Issued in CA

Practice address

354 W Foothill Blvd
Claremont, CA 91711-2709

Phone

(909) 624-1215

NPI assigned

Dec 27, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1640563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640563200000",
    "number": "1194485532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14051 ROBIN CREST LN",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917094822",
            "telephone_number": "951-751-5233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 W FOOTHILL BLVD",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917112709",
            "telephone_number": "909-624-1215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MIRANDA",
        "middle_name": "RENEE",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-27",
        "last_updated": "2021-12-27",
        "certification_date": "2021-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "95019330",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "95019330",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Claremont",
            "affiliation": "N",
            "address_1": "354 W Foothill Blvd",
            "city": "Claremont",
            "state": "CA",
            "country_code": "US",
            "postal_code": "917112709",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Athena Marie Wildman
• William G Sinclair Jr DMD Inc
• Michele E Williams, LPCC
• Hilda Ann Williamson, LCSW
• Frank J Wills
• Celest I. Winfrey, LM, CPM, IBCLC
• Kara Wollach, MD
• Women Rise Psychological and Wellness Center, P.C.
• Greg Wondoloski
• Christine Wong, PSY.D.

• Family Medicine Physician in Claremont, CA
• Providers in Claremont, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.