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General NPI Number Information
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NPI Number | 1003452749
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Entity Type | Individual
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Provider Name | ANTOINETTE MILLER
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Gender | Female
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Dates
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Enumeration Date | 11/18/2019
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Last Update Date | 06/15/2026
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Provider Practice Location Address
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Address Line | 15820 W JEFFERSON ST
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City | GOODYEAR
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State | AZ
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Zip | 85338-6893
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Country | US
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Telephone | 480-278-6343
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Fax |
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Provider Business Mailing Address
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Address Line | 6141 E GRANT RD BLDG A
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City | TUCSON
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State | AZ
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Zip | 85712-5829
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 13650767
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 13650767
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License Number State | AZ
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