Healthcare Provider Details

I. General information

NPI: 1699007641
Provider Name (Legal Business Name): SUZANNE MILLER R.D., L.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 MUIRS CHAPEL RD SUITE 100
GREENSBORO NC
27410-6173
US

IV. Provider business mailing address

1507 FOX HOLLOW RD
GREENSBORO NC
27410-3747
US

V. Phone/Fax

Practice location:
  • Phone: 336-542-2892
  • Fax: 336-834-0442
Mailing address:
  • Phone: 336-297-1393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL001210
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: