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General NPI Number Information
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NPI Number | 1174708218
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Entity Type | Individual
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Provider Name | ROXANNE MILLER SIDES CRNP
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Gender | Female
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 05/09/2014
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Provider Practice Location Address
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Address Line | 680 BLAIR MILL RD
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City | HORSHAM
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State | PA
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Zip | 19044-2223
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Country | US
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Telephone | 866-297-9232
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Fax |
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Provider Business Mailing Address
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Address Line | 514 FARNUM RD
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City | MEDIA
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State | PA
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Zip | 19063-1610
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Country | US
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Telephone | 610-566-2975
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP009693
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License Number State | PA
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