Miranda Nicole Blaine

Primary specialty

PharmacistTaxonomy code 183500000X

License

5302414594 Issued in MI

Practice address

8364 Byron Center Ave SW
Byron Center, MI 49315-7805

Phone

(616) 878-0497

NPI assigned

Jan 4, 2022

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Walgreen Co

  • Pharmacy
  • Byron Center, MI
  • NPI 1336154640
  NPD
• Walgreen Co

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 23, 2022.

{
    "created_epoch": "1641254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671753600000",
    "number": "1972264786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8364 BYRON CENTER AVE SW",
            "city": "BYRON CENTER",
            "state": "MI",
            "postal_code": "493157805",
            "telephone_number": "616-878-0497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8364 BYRON CENTER AVE SW",
            "city": "BYRON CENTER",
            "state": "MI",
            "postal_code": "493157805",
            "telephone_number": "616-878-0497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAINE",
        "first_name": "MIRANDA",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-04",
        "last_updated": "2022-12-23",
        "certification_date": "2022-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5302414594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beville Counseling LLC
• David James Beyers
• BH JV Grand Rapids LLC
• Ingrid Eerdmans Bierfeldt, M.D.
• Shawna Biggs, MA, LPC
• Lindsey Nicole Bandy Blodgett, LPC
• Bluebird Behavioral Services, LLC
• Iris Boettcher, MD
• Savannah Boomstra
• Carly Jo Boss, AGPCNP

• All providers in Byron Center, MI
• Pharmacist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2022; 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.