Provider Demographics
NPI:1497778542
Name:MILLER, SHAWNA DEA (ARNP)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:DEA
Last Name:MILLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:KS
Mailing Address - Zip Code:67844-0272
Mailing Address - Country:US
Mailing Address - Phone:620-646-5867
Mailing Address - Fax:
Practice Address - Street 1:423 1/2 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FOWLER
Practice Address - State:KS
Practice Address - Zip Code:67844
Practice Address - Country:US
Practice Address - Phone:620-873-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45646363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily