Provider Demographics
NPI:1003125444
Name:MILLER, SANDRA ELLEN (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ELLEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:WEST CHAZY
Mailing Address - State:NY
Mailing Address - Zip Code:12992-2562
Mailing Address - Country:US
Mailing Address - Phone:518-566-8052
Mailing Address - Fax:518-563-8343
Practice Address - Street 1:37 EAGLE WAY
Practice Address - Street 2:
Practice Address - City:WEST CHAZY
Practice Address - State:NY
Practice Address - Zip Code:12992-2562
Practice Address - Country:US
Practice Address - Phone:518-566-8052
Practice Address - Fax:518-563-8343
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3619061163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool