Basic Information
| Provider Information | |||||||||
| NPI: | 1386812329 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOUST | ||||||||
| FirstName: | MIRANDA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11211 SE 82ND AVE STE O | ||||||||
| Address2: | |||||||||
| City: | HAPPY VALLEY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970867641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036558585 | ||||||||
| FaxNumber: | 5037226545 | ||||||||
| Practice Location | |||||||||
| Address1: | 11211 SE 82ND AVE STE O | ||||||||
| Address2: | |||||||||
| City: | HAPPY VALLEY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970867641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036558585 | ||||||||
| FaxNumber: | 5037226545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2008 | ||||||||
| LastUpdateDate: | 12/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 201392158NP-PP | OR | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 163WP0808X | 201143233RN | OR | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LC1500X | 201392158NP | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Community Health | 364SP0808X | 201392158NP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health |
No ID Information.