Provider Demographics
NPI:1255316477
Name:SJOGREN-MILLER, BETH A (APRN,BC)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:SJOGREN-MILLER
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 COURT ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-3471
Mailing Address - Country:US
Mailing Address - Phone:413-695-1138
Mailing Address - Fax:413-529-9961
Practice Address - Street 1:30 COURT ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-3471
Practice Address - Country:US
Practice Address - Phone:413-695-1138
Practice Address - Fax:413-529-9961
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA148178-PC364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NS0333Medicare ID - Type Unspecified