Healthcare Provider Details

I. General information

NPI: 1326214347
Provider Name (Legal Business Name): CARRIE LYNN MILLER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SHATTO PL STE 100
LOS ANGELES CA
90020-1747
US

IV. Provider business mailing address

501 SHATTO PL STE 100 SUITE100
LOS ANGELES CA
90020-1747
US

V. Phone/Fax

Practice location:
  • Phone: 888-428-3223
  • Fax: 323-866-1881
Mailing address:
  • Phone: 888-428-3223
  • Fax: 323-866-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.006364
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: