Miranda Michelle Van Dam, CSFA

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

License

205983 Issued in ID

Practice address

500 S. Eagle Rd.
Meridian, ID 83642

Phone

(208) 706-8101

NPI assigned

Dec 10, 2021

Last updated

Dec 10, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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": "1639094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639094400000",
    "number": "1902565682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3595 W SPRUCE CREEK DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836424217",
            "telephone_number": "208-602-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S. EAGLE RD.",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83642",
            "telephone_number": "208-706-8101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DAM",
        "first_name": "MIRANDA",
        "middle_name": "MICHELLE",
        "credential": "CSFA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-10",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "ID",
            "license": "205983",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL BOARD OF SURGICAL TECHNOLOGY AND SURGICAL ASSISTING",
            "identifier": "205983",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vandamm@slhs.org",
            "affiliation": "N",
            "address_1": "520 S Eagle Rd",
            "city": "Meridian",
            "state": "ID",
            "country_code": "US",
            "postal_code": "836426351",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lauren Mariet Valentine, DPT
• Michael Andrew Valerio, PA
• Ana Colleen Valle, MA
• Valley Medical LLC
• Valor Family Therapy
• Benjamin Alexander Van Hoogen, FNP-C
• Chelsea Marie Van Wagenen, RN, NTP, RWS
• Klaas Vanden Beld, NP
• Brian P Vandendries, NP
• Kayla Vander Stelt

• Surgical Assistant in Meridian, ID
• Providers in Meridian, ID by specialty
• Surgical Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 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.