Provider Demographics
NPI:1265563753
Name:MILLER, SUE CAROL
Entity type:Individual
Prefix:MRS
First Name:SUE
Middle Name:CAROL
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 1:44237 SEDONA WAY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-6210
Mailing Address - Country:US
Mailing Address - Phone:661-949-0505
Mailing Address - Fax:
Practice Address - Street 1:190 SIERRA CT STE C8
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-7609
Practice Address - Country:US
Practice Address - Phone:661-266-4783
Practice Address - Fax:661-267-1250
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator