Provider Demographics
NPI:1760094411
Name:MILLER, SHANNON CHRISTINE
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:CHRISTINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:CHRISTINE
Other - Last Name:POINTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1750 NEW MEXICO ST
Mailing Address - Street 2:
Mailing Address - City:GREEN RIVER
Mailing Address - State:WY
Mailing Address - Zip Code:82935-6252
Mailing Address - Country:US
Mailing Address - Phone:307-871-4588
Mailing Address - Fax:
Practice Address - Street 1:1750 NEW MEXICO ST
Practice Address - Street 2:
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935-6252
Practice Address - Country:US
Practice Address - Phone:307-871-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care