Provider Demographics
NPI:1871092155
Name:OGDEN, MIRANDA CHRISTINE (RN, MSN, NP-C)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:CHRISTINE
Last Name:OGDEN
Suffix:
Gender:F
Credentials:RN, MSN, NP-C
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:CHRISTINE
Other - Last Name:JARMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1067 W 125 S
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-6058
Mailing Address - Country:US
Mailing Address - Phone:208-317-6285
Mailing Address - Fax:
Practice Address - Street 1:2680 CHANNING WAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7517
Practice Address - Country:US
Practice Address - Phone:208-523-7667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID57772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily