Healthcare Provider Details

I. General information

NPI: 1881304236
Provider Name (Legal Business Name): GRACE MILLER RN, BSN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 4TH ST
PASO ROBLES CA
93446
US

IV. Provider business mailing address

805 4TH ST
PASO ROBLES CA
93446
US

V. Phone/Fax

Practice location:
  • Phone: 805-704-7701
  • Fax:
Mailing address:
  • Phone: 805-704-7701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number562131
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: