Provider Demographics
NPI:1912563735
Name:MILLER, SARAH LAVONNE (RN, ICEA, CLEC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LAVONNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN, ICEA, CLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 N KENMORE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-6274
Mailing Address - Country:US
Mailing Address - Phone:701-429-0423
Mailing Address - Fax:
Practice Address - Street 1:144 N KENMORE AVE APT 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-6274
Practice Address - Country:US
Practice Address - Phone:701-429-0423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA792026207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics