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NPI Code Detail

MEDICARE: MS. SUSAN T. MILLER A.P.R.N.,B.C.

MEDICARE: MS. SUSAN T. MILLER A.P.R.N.,B.C.
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner1953014405UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1104502OTHERUTU005
2107002817101OTHERUTU006
3262112OTHERUTU002

General Provider Information

NPI Number : 1528045457
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN T. MILLER A.P.R.N.,B.C.
Provider Business Mailing Address
First Line : 2528 DEARBORN ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-3512
Country : US
Telephone Number : 801-466-5978
Fax Number :
Provider Business Practice Location Address
First Line : 3809 W 6200 S
Second Line :
City : KEARNS
State : UT
Zip : 84118-3725
Country : US
Telephone Number : 801-963-4213
Fax Number : 801-963-4299
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2005
Last Update Date : 07/08/2007

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