Healthcare Provider Details

I. General information

NPI: 1477743540
Provider Name (Legal Business Name): MS. SANDRA R MILTEER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 CRIPPLE CREEK LN
SUFFOLK VA
23434-4169
US

IV. Provider business mailing address

817 CRIPPLE CREEK LN
SUFFOLK VA
23434-4169
US

V. Phone/Fax

Practice location:
  • Phone: 757-934-0278
  • Fax:
Mailing address:
  • Phone: 757-934-0278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number1401036742
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number1401036742
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: