Provider Demographics
NPI:1982686440
Name:MILLER, DIANA SABO (RNC,ANP)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:SABO
Last Name:MILLER
Suffix:
Gender:F
Credentials:RNC,ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 W 5TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2752
Mailing Address - Country:US
Mailing Address - Phone:307-672-2522
Mailing Address - Fax:307-672-3732
Practice Address - Street 1:1333 W 5TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2752
Practice Address - Country:US
Practice Address - Phone:307-672-2522
Practice Address - Fax:307-672-3732
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY11269.056363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY110391101Medicaid
WY11269.056OtherSTATE LICENSE NUMBER
MT0437320Medicaid
MT0437320Medicaid
WY110391101Medicaid
WY11269.056OtherSTATE LICENSE NUMBER