MEDICARE: SANDRA MILLER APRN

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	363LF0000X	Family Nurse Practitioner	149441-4405	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437105269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA MILLER APRN

Provider Business Mailing Address
First Line	:	766 S 400 E
Second Line	:
City	:	OREM
State	:	UT
Zip	:	84097-6300
Country	:	US
Telephone Number	:	801-376-6082
Fax Number	:

Provider Business Practice Location Address
First Line	:	252 W KESTREL DRIVE
Second Line	:
City	:	SARATOGA SPRINGS
State	:	UT
Zip	:	84045-6010
Country	:	US
Telephone Number	:	801-756-3511
Fax Number	:

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	08/29/2008

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