Healthcare Provider Details

I. General information

NPI: 1528045457
Provider Name (Legal Business Name): SUSAN T. MILLER A.P.R.N.,B.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 W 6200 S
KEARNS UT
84118-3725
US

IV. Provider business mailing address

2528 DEARBORN ST
SALT LAKE CITY UT
84106-3512
US

V. Phone/Fax

Practice location:
  • Phone: 801-963-4213
  • Fax: 801-963-4299
Mailing address:
  • Phone: 801-466-5978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1953014405
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier104502
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerU005
# 2
Identifier107002817101
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerU006
# 3
Identifier262112
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerU002

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: