Provider Demographics
NPI:1700213394
Name:MILLER, SHEILA ANN
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:ANN
Last Name:MILLER
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 1:25073 MARCELLUS HWY
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047-9469
Mailing Address - Country:US
Mailing Address - Phone:269-782-6826
Mailing Address - Fax:269-462-9243
Practice Address - Street 1:25073 MARCELLUS HWY
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-9469
Practice Address - Country:US
Practice Address - Phone:269-782-6826
Practice Address - Fax:269-462-9243
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF140067706311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home