Healthcare Provider Details

I. General information

NPI: 1891101671
Provider Name (Legal Business Name): SHUSHAUN BADALIAN MILLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N DEVINE RD STE B
VANCOUVER WA
98661-6979
US

IV. Provider business mailing address

18 NW 20TH AVE STE 101
BATTLE GROUND WA
98604-4175
US

V. Phone/Fax

Practice location:
  • Phone: 360-952-4457
  • Fax: 360-828-7409
Mailing address:
  • Phone: 360-952-4457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60650650
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024171789
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20150571NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: