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General NPI Number Information
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NPI Number | 1295388361
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Entity Type | Individual
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Provider Name | STACY HATSUMI MILLER ATC
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Gender | Female
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Dates
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Enumeration Date | 07/18/2019
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 1919 SPANOS CT
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City | SACRAMENTO
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State | CA
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Zip | 95825-3981
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Country | US
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Telephone | 916-568-3041
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Fax |
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Provider Business Mailing Address
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Address Line | 12147 BLAKE RD
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City | WILTON
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State | CA
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Zip | 95693-8534
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Country | US
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Telephone | 916-996-8861
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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