Provider Demographics
NPI:1649893124
Name:MILLER, SARA
Entity type:Individual
Prefix:
First Name:SARA
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 1:1501 BALDWIN ST
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:IA
Mailing Address - Zip Code:51537-1539
Mailing Address - Country:US
Mailing Address - Phone:712-579-8416
Mailing Address - Fax:712-733-3334
Practice Address - Street 1:1501 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IA
Practice Address - Zip Code:51537-1539
Practice Address - Country:US
Practice Address - Phone:712-579-8416
Practice Address - Fax:712-733-3334
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health