Healthcare Provider Details

I. General information

NPI: 1780614156
Provider Name (Legal Business Name): SHIRLEY LYNN MILLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MDG 2501 CAPEHART RD
OFFUTT AFB NE
68112
US

IV. Provider business mailing address

3606 BECKER CT
PLATTSMOUTH NE
68048-7100
US

V. Phone/Fax

Practice location:
  • Phone: 402-294-2448
  • Fax:
Mailing address:
  • Phone: 402-296-2856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18194
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: