Healthcare Provider Details

I. General information

NPI: 1164571881
Provider Name (Legal Business Name): LORIE A MILLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 S GILBERT RD
GILBERT AZ
85296-1016
US

IV. Provider business mailing address

4132 E STANFORD AVE
HIGLEY AZ
85236-3568
US

V. Phone/Fax

Practice location:
  • Phone: 480-545-3826
  • Fax: 480-632-4731
Mailing address:
  • Phone: 480-924-7511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN091298
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: