Provider Demographics
NPI:1972659381
Name:MILES, SANDRA LYNN (CNA, CPT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:MILES
Suffix:
Gender:F
Credentials:CNA, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1362 N GATEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37854-4108
Mailing Address - Country:US
Mailing Address - Phone:865-354-1220
Mailing Address - Fax:865-354-0112
Practice Address - Street 1:1362 N GATEWAY AVE
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:TN
Practice Address - Zip Code:37854-4108
Practice Address - Country:US
Practice Address - Phone:865-354-1220
Practice Address - Fax:865-354-0112
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN246RP1900X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Not Answered376K00000XNursing Service Related ProvidersNurse's Aide