Healthcare Provider Details

I. General information

NPI: 1740019991
Provider Name (Legal Business Name): MS. SARAH LYNN MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2024
Last Update Date: 07/27/2024
Certification Date: 07/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDRENS WAY
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

1747 THOMAS AVE APT C
SAN DIEGO CA
92109-4479
US

V. Phone/Fax

Practice location:
  • Phone: 517-576-1400
  • Fax:
Mailing address:
  • Phone: 517-410-5218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number641045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: