MEDICARE: SHARON JEAN MILES LMSW

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	104100000X	Social Worker	M-2217	NM

General Provider Information

NPI Number	:	1548562770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON JEAN MILES LMSW

Provider Business Mailing Address
First Line	:	2700 VISTA GRANDE DR NW UNIT 10
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-1040
Country	:	US
Telephone Number	:	505-836-5794
Fax Number	:	505-836-2254

Provider Business Practice Location Address
First Line	:	2700 VISTA GRANDE DR NW UNIT 10
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-1040
Country	:	US
Telephone Number	:	505-836-5794
Fax Number	:	505-836-2254

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

Provider Enumeration Date	:	11/19/2010
Last Update Date	:	11/19/2010

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