MEDICARE: MS. ELIZABETH DIANE MILLER RN, PHN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC1500X	Community Health Registered Nurse	302315	CA

General Provider Information

NPI Number	:	1184797698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH DIANE MILLER RN, PHN

Provider Business Mailing Address
First Line	:	628 4TH ST
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95695-4016
Country	:	US
Telephone Number	:	530-669-3521
Fax Number	:

Provider Business Practice Location Address
First Line	:	137 NORTH COTTONWOOD STREET
Second Line	:	SUITE 2200
City	:	WOODLAND
State	:	CA
Zip	:	95695-2666
Country	:	US
Telephone Number	:	530-666-8241
Fax Number	:	530-666-1809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/08/2007

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