Healthcare Provider Details

I. General information

NPI: 1437183803
Provider Name (Legal Business Name): SANDRA GALE MILLER DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6549 TOWN CENTER DR STE A
CLARKSTON MI
48346-4824
US

IV. Provider business mailing address

8611 FREDERICK DR
WASHINGTON MI
48094-2961
US

V. Phone/Fax

Practice location:
  • Phone: 800-395-3223
  • Fax: 586-323-3568
Mailing address:
  • Phone: 586-786-7519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704110285
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: