Healthcare Provider Details

I. General information

NPI: 1861550808
Provider Name (Legal Business Name): ROBERT EDWARD MILLER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 PEACEKEEPER WAY BLDG 209
MCCLELLAN CA
95652-2600
US

IV. Provider business mailing address

6720 LINDA SUE WAY
FAIR OAKS CA
95628-3024
US

V. Phone/Fax

Practice location:
  • Phone: 916-830-1526
  • Fax: 916-929-1861
Mailing address:
  • Phone: 916-847-4570
  • Fax: 916-965-8956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number560859
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number560859
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number560859
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number560859
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License Number560859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: