Mrs Miranda R Dethier, PA-C in Menomonee Falls, WI

Mrs Miranda R Dethier, PA-C is a medicare enrolled "Physician Assistant" in Menomonee Falls, Wisconsin. Her current practice location is W165n5595 Creekwood Xing, Menomonee Falls, Wisconsin. You can reach out to her office (for appointments etc.) via phone at (262) 252-1050.

Mrs Miranda R Dethier is licensed to practice in Wisconsin (license number 2758-23) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1760770960.

Contact Information

	Mrs Miranda R Dethier, PA-C
	W165n5595 Creekwood Xing, Menomonee Falls, WI 53051-0685
	(262) 252-1050
	(262) 525-4781

Map and Direction

Provider's Profile

Full Name	Mrs Miranda R Dethier
Gender	Female
Speciality	Physician Assistant
Location	W165n5595 Creekwood Xing, Menomonee Falls, Wisconsin
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1760770960
Provider Enumeration Date: 07/21/2011
Last Update Date: 06/23/2026

Medicare PECOS Information:

PECOS PAC ID: 3779752548
Enrollment ID: I20110811000731

Medical Identifiers

Medical identifiers for Mrs Miranda R Dethier such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1760770960	NPI	-	NPPES
1760770960	Medicaid	WI

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363A00000X	Physician Assistant	2758-23 (Wisconsin)	Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Miranda R Dethier is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Mrs Miranda R Dethier, PA-C 470 E Red Pine Cir, Dousman, WI 53118-8828 Ph: (608) 921-8334	Mrs Miranda R Dethier, PA-C W165n5595 Creekwood Xing, Menomonee Falls, WI 53051-0685 Ph: (262) 252-1050

Reviews and Comments

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Mrs Miranda R Dethier, PA-C - Medicare Physician Assistant in Menomonee Falls, WI