Healthcare Provider Details

I. General information

NPI: 1689882573
Provider Name (Legal Business Name): SUSAN ANN MILLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN MARKLEY

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ROCKY MOUNTAIN AVE STE 100
LOVELAND CO
80538-9004
US

IV. Provider business mailing address

2500 ROCKY MOUNTAIN AVE SUITE 100
LOVELAND CO
80538-9004
US

V. Phone/Fax

Practice location:
  • Phone: 970-624-1800
  • Fax: 970-624-1891
Mailing address:
  • Phone: 970-624-1800
  • Fax: 970-624-1891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5118
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number77001
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: