Provider Demographics
NPI:1922797166
Name:MILLER, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
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 1:1502 N SAND CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BOGGSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46110-9719
Mailing Address - Country:US
Mailing Address - Phone:317-319-0583
Mailing Address - Fax:
Practice Address - Street 1:1502 N SAND CREEK RD
Practice Address - Street 2:
Practice Address - City:BOGGSTOWN
Practice Address - State:IN
Practice Address - Zip Code:46110-9719
Practice Address - Country:US
Practice Address - Phone:317-310-5983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10004099A363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant