Most Relevant Information
Provider Data
| NPI Number: | 1003527300 |
| Provider Name: | ALEXIS BREANNE MIRANDA |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/07/2022 |
| Last Updated: | 12/07/2022 |
Provider Practice Location
111 NORTH ST
RAPID CITY
SD
577011163
Practice Location Phone/Fax
| Phone: | 6053430650 |
| Fax: | 6053423692 |
Provider Mailing Location
350 ELK ST
RAPID CITY
SD
577017351
Provider Mailing Phone/Fax
| Phone: | 6053437262 |
| Fax: | 6053437293 |