MEDICARE: SANDRA DENISE MILES

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	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1376143214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA DENISE MILES

Provider Business Mailing Address
First Line	:	4525 BAUX MOUNTAIN RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-2457
Country	:	US
Telephone Number	:	336-995-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	4525 BAUX MOUNTAIN RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-2457
Country	:	US
Telephone Number	:	336-995-5700
Fax Number	:

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

Provider Enumeration Date	:	10/29/2020
Last Update Date	:	10/29/2020

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Directions to “ SANDRA DENISE MILES ” Practice Location

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