Provider Demographics
NPI:1003933557
Name:MILLER, SHANAKA (LMP)
Entity Type:Individual
Prefix:MRS
First Name:SHANAKA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 COLLEGE ST SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-2366
Mailing Address - Country:US
Mailing Address - Phone:360-459-1320
Mailing Address - Fax:360-923-1940
Practice Address - Street 1:1320 COLLEGE ST SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-2366
Practice Address - Country:US
Practice Address - Phone:360-459-1320
Practice Address - Fax:360-923-1940
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011258174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist