Provider Demographics
NPI:1710394333
Name:MILLER, SUSIE (RN)
Entity Type:Individual
Prefix:
First Name:SUSIE
Middle Name:
Last Name:MILLER
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 1:3308 FM 992 N
Mailing Address - Street 2:
Mailing Address - City:DE KALB
Mailing Address - State:TX
Mailing Address - Zip Code:75559-6139
Mailing Address - Country:US
Mailing Address - Phone:903-792-3006
Mailing Address - Fax:903-792-3044
Practice Address - Street 1:5495 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4608
Practice Address - Country:US
Practice Address - Phone:903-792-3006
Practice Address - Fax:903-792-3044
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX778719251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management