Healthcare Provider Details

I. General information

NPI: 1770101172
Provider Name (Legal Business Name): SHAYNA MILLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2020
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 W UNION HILLS DR
GLENDALE AZ
85308-2429
US

IV. Provider business mailing address

13838 N 36TH AVE
PHOENIX AZ
85053-5503
US

V. Phone/Fax

Practice location:
  • Phone: 623-328-8630
  • Fax:
Mailing address:
  • Phone: 707-364-0119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN207838
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number253084
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: