Miranda Alexandria Zerrusen

Primary specialty

PharmacistTaxonomy code 183500000X

License

051301319 Issued in IL

Practice address

101 Dettro Dr
Mattoon, IL 61938-9044

Phone

(172) 586-3132

NPI assigned

Oct 28, 2020

Last updated

Oct 28, 2020By the provider in NPPES

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

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": "1603843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1437759586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 DETTRO DR",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619389044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 DETTRO DR",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619389044",
            "telephone_number": "172-586-3132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZERRUSEN",
        "first_name": "MIRANDA",
        "middle_name": "ALEXANDRIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-28",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051301319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Yurs
• Maamoun Zane, M.D.
• Brian Zapanta, MD
• Andrew Z. Zasada, M.D.
• Emily Y Zerrusen, M.A.
• Sarah E. Zike, B.A.
• Amanda Zumbahlen, APN
• Luke Ray Zumbahlen, FNP-C
• Gwen Zumwalt

• Pharmacist in Mattoon, IL
• Providers in Mattoon, IL by specialty
• Pharmacist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; 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.