Provider Demographics
NPI:1679707640
Name:KNOX, MIRANDA VERONICA (MSTOM)
Entity type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:VERONICA
Last Name:KNOX
Suffix:
Gender:F
Credentials:MSTOM
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Mailing Address - Street 1:904 E PEARSON ST
Mailing Address - Street 2:#120
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1594
Mailing Address - Country:US
Mailing Address - Phone:608-695-0522
Mailing Address - Fax:414-225-9438
Practice Address - Street 1:904 E PEARSON ST
Practice Address - Street 2:#120
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-1594
Practice Address - Country:US
Practice Address - Phone:608-695-0522
Practice Address - Fax:414-225-9438
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI461-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist