Petruska, Miranda

Petruska, Miranda is an individual health care provider with primary practice located at 118 E 8Th St , Port Angeles WA 98362-6129. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Community Health Worker, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Petruska, Miranda can be contacted via phone (360) 457-0431.

Contact Information

Primary practice address
118 E 8Th St Port Angeles WA 98362-6129
Phone: (360) 457-0431
Fax: (360) 457-0493
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Community Health Worker 172V00000X
Behavioral Health & Social Service Providers / Clinical 1041C0700X

Profile Details

NPI number 1922375716
LBN Legal business name Petruska, Miranda
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 21st, 2011
Last updated May 1st, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922375716 NPPES
Alaska MEDICAID MDH0157

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