Provider Demographics
NPI:1346022597
Name:MILLER, SANDRA LOPEZ (FNP-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LOPEZ
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 OLD SPANISH TRL
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-7307
Mailing Address - Country:US
Mailing Address - Phone:830-491-7907
Mailing Address - Fax:
Practice Address - Street 1:3415 OLD SPANISH TRL
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-7307
Practice Address - Country:US
Practice Address - Phone:830-491-7907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1140066363L00000X
TX880673163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse