Provider Demographics
NPI:1518524214
Name:MILES, SARAH J (APRN, MSN, CNM)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:J
Last Name:MILES
Suffix:
Gender:F
Credentials:APRN, MSN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:659 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2118
Practice Address - Country:US
Practice Address - Phone:312-707-8988
Practice Address - Fax:312-707-9223
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2022-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085002056Medicaid