| Doctor Name: | MIRANDA K DETORE |
| NPI Number: | 1720471774 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 133599 |
| Business Practice Address: | 200 Commons Way Ste B Kalispell, MT - 599011915 |
| Business Phone Number: | 4067525170 |
| Business Fax Number: | 4067525210 |
| Mailing Address: | 200 Commons Way Ste B, KALISPELL |
| State: | MT |
| Postal Code: | 599011915 |
| Phone Number: | 4067525170 |
| Fax Number: | 4067525210 |
| NPI Enumeration Date: | 03/16/2015 |
| NPI Last Update Date: | 03/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 146L00000X |
| License Number: | 133599 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Emergency Medical Service Providers |
| Taxonomy Classification: | Emergency Medical Technician, Paramedic |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An EMT, Paramedic is an individual trained and certified to perform advanced life support (ALS) in medical emergencies based on individual state boards. |