Provider Demographics
NPI:1376930693
Name:MILLER, HEATHER LEAANNE (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEAANNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LEAANNE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1140 E 3900 S STE 390
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1256
Mailing Address - Country:US
Mailing Address - Phone:801-743-4700
Mailing Address - Fax:801-743-4705
Practice Address - Street 1:1140 E 3900 S STE 390
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1256
Practice Address - Country:US
Practice Address - Phone:801-743-4700
Practice Address - Fax:801-743-4705
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR74941207V00000X
UT6760255-1205207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology