Provider Demographics
NPI:1083834154
Name:MILLER, DOLORES MAY
Entity Type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:MAY
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 QUAIL RUN DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-3550
Mailing Address - Country:US
Mailing Address - Phone:520-459-0170
Mailing Address - Fax:520-459-1241
Practice Address - Street 1:3512 QUAIL RUN DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-3550
Practice Address - Country:US
Practice Address - Phone:520-459-0170
Practice Address - Fax:520-459-1241
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ02029087225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3962940001Medicare NSC