Provider Demographics
NPI:1477743540
Name:MILTEER, SANDRA R
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:R
Last Name:MILTEER
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 1:817 CRIPPLE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4169
Mailing Address - Country:US
Mailing Address - Phone:757-934-0278
Mailing Address - Fax:
Practice Address - Street 1:817 CRIPPLE CREEK LN
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4169
Practice Address - Country:US
Practice Address - Phone:757-934-0278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401036742374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide