Active NPI
Miranda Christmas, CSA
- Surgical Technologist
- Libertyville, IL
National Provider Identifier
1730435041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Technologist
- License
- 3943
- Practice address
- 801 S Milwaukee Ave
Libertyville, IL 60048-3204 - Phone
- (262) 497-9446
- NPI assigned
- Jul 24, 2012
- Last updated
- Jul 24, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Technologist | 246ZS0410X | 3943 | WI | Primary |
Addresses
Primary practice location
801 S Milwaukee Ave
Libertyville, IL 60048-3204
Mailing address
2604 21St St
Kenosha, WI 53140-1775
Phone (262) 497-9446
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3843 | Other | WI | NATIONAL SURGICAL ASSISTANT ASSOCIATION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3943 | WI | MD | Surgical Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343088000000",
"number": "1730435041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2604 21ST ST",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531401775",
"telephone_number": "262-497-9446"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 S MILWAUKEE AVE",
"city": "LIBERTYVILLE",
"state": "IL",
"postal_code": "600483204",
"telephone_number": "262-497-9446"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHRISTMAS",
"first_name": "MIRANDA",
"name_prefix": "Ms.",
"credential": "CSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-07-24",
"last_updated": "2012-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "246ZS0410X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Technologist",
"state": "WI",
"license": "3943",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL SURGICAL ASSISTANT ASSOCIATION",
"identifier": "3843",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Libertyville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.