Provider Demographics
NPI:1245816016
Name:MILLER, STARLA LUCILLE (RN)
Entity type:Individual
Prefix:
First Name:STARLA
Middle Name:LUCILLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:STARLA
Other - Middle Name:LUCILLE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11145 E SOMBRA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-5200
Mailing Address - Country:US
Mailing Address - Phone:480-365-8454
Mailing Address - Fax:
Practice Address - Street 1:11145 E SOMBRA AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-5200
Practice Address - Country:US
Practice Address - Phone:480-365-8454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN143747163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse