Provider Demographics
NPI:1528590874
Name:MILES, SUSAN B (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:B
Last Name:MILES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 JAMES I. HARRISON JR. PARKWAY E.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405
Mailing Address - Country:US
Mailing Address - Phone:205-562-1802
Mailing Address - Fax:205-633-3833
Practice Address - Street 1:1400 JAMES I. HARRISON JR. PARKWAY E.
Practice Address - Street 2:SUITE 100
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405
Practice Address - Country:US
Practice Address - Phone:205-562-1802
Practice Address - Fax:205-633-3833
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-081949163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse