Provider Demographics
NPI:1235786146
Name:MILLER, SHELBY ELAINE (APRN)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:ELAINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4756 N TOSCANA HILLS DR
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7755
Mailing Address - Country:US
Mailing Address - Phone:801-831-9655
Mailing Address - Fax:
Practice Address - Street 1:11340 S STATE ST
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5145
Practice Address - Country:US
Practice Address - Phone:801-529-8628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-25
Last Update Date:2019-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8769747-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily