MEDICARE: MS. DANIELLE NICOLE MILLER HIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	HADE12722	AZ

General Provider Information

NPI Number	:	1366169682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANIELLE NICOLE MILLER HIS

Provider Business Mailing Address
First Line	:	4129 E INDIAN SCHOOL RD APT 230
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-5386
Country	:	US
Telephone Number	:	480-440-8462
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 E MCDOWELL RD STE 200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2608
Country	:	US
Telephone Number	:	602-956-1250
Fax Number	:	602-956-7466

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2022
Last Update Date	:	11/29/2022

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