MEDICARE: SANDRA L MILLER CNP

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	R0148350250	SD
2	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	R0148350250	SD
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	CP000250	SD

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	:	1952344699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA L MILLER CNP

Provider Business Mailing Address
First Line	:	677 CATHEDRAL DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-6018
Country	:	US
Telephone Number	:	605-343-9224
Fax Number	:	605-342-1359

Provider Business Practice Location Address
First Line	:	636 SAINT ANNE ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-4694
Country	:	US
Telephone Number	:	605-348-8000
Fax Number	:	605-348-4315

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	12/05/2018

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