Miranda Black, L.AC.
Individual provider Active NPI Acupuncturist · Grants Pass, OR
NPI 1902049554 · NPPES record last updated Jun 13, 2013
Key facts
- NPI
- 1902049554
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Acupuncturist 171100000X
- License
- AC01255 (OR)
- Practice address
- 228 NW B St
Grants Pass, OR 97526-2032 - Phone
- (541) 244-0111
- NPI assigned
- Apr 13, 2009
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AC01255 | OR | MD | Acupuncturist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AC01255 | OR | Yes |
Addresses
Primary practice location
228 NW B St
Grants Pass, OR 97526-2032
Mailing address
228 NW B St
Grants Pass, OR 97526-2032
Phone (541) 244-0111
Other providers in Grants Pass, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2013. 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.