MEDICARE: MS. SHIRLEY A MILLINER

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	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1205918703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHIRLEY A MILLINER

Provider Business Mailing Address
First Line	:	215 N. MAGNOLIA ST.
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29151-1946
Country	:	US
Telephone Number	:	803-775-9364
Fax Number	:	803-773-6615

Provider Business Practice Location Address
First Line	:	503A BLOOMVILLE RD.
Second Line	:
City	:	MANNING
State	:	SC
Zip	:	29102
Country	:	US
Telephone Number	:	803-435-9737
Fax Number	:	803-435-9838

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/08/2007

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