| Miranova Health Pllc | |
|
715 9th Ave Seattle WA 98104-2066 | |
| (206) 902-4582 | |
| (206) 902-4159 |
| Full Name | Miranova Health Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 715 9th Ave, Seattle, Washington |
| Authorized Official Name and Position | Emily Nancy Hanson (MEDICAL DIRECTOR) |
| Authorized Official Contact | 9522404258 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Miranova Health Pllc Po Box 21249 Seattle WA 98111-3249 Ph: (206) 902-4582 | Miranova Health Pllc 715 9th Ave Seattle WA 98104-2066 Ph: (206) 902-4582 |
| NPI Number | 1932730447 |
|---|---|
| Provider Enumeration Date | 02/03/2020 |
| Last Update Date | 02/03/2020 |
| Medicare PECOS PAC ID | 6800225624 |
|---|---|
| Medicare Enrollment ID | O20200331000032 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932730447 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Elisa Richardson Lombard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780849935 PECOS PAC ID: 2163599218 Enrollment ID: I20080916000327 |
| Provider Name | Lidia Wiersum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558605071 PECOS PAC ID: 4880849363 Enrollment ID: I20130307000299 |
| Provider Name | Ann Pedack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215337399 PECOS PAC ID: 3678899952 Enrollment ID: I20150304000443 |
| Provider Name | Emily N Hanson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255597035 PECOS PAC ID: 8325219868 Enrollment ID: I20150821014426 |
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