1184976052 NPI number — MRS. MICHELLE RENEA MILLER

Table of content: MRS. MICHELLE RENEA MILLER (NPI 1184976052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184976052 NPI number — MRS. MICHELLE RENEA MILLER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
MICHELLE
Provider Middle Name:
RENEA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COPE
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
RENEA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184976052
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11840 W ROSE GARDEN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUN CITY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85373-9717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-204-6227
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11840 W ROSE GARDEN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUN CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85373-9717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-204-6227
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2355S0801X , with the licence number:  SLPA7851 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)