Provider Demographics
NPI:1669707444
Name:MILES, SHELLEY RUTH (LAC, RN)
Entity type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:RUTH
Last Name:MILES
Suffix:
Gender:F
Credentials:LAC, RN
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Mailing Address - Street 1:1324 COMMON ST
Mailing Address - Street 2:STE 306
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3565
Mailing Address - Country:US
Mailing Address - Phone:830-608-1403
Mailing Address - Fax:830-608-1400
Practice Address - Street 1:1324 COMMON ST
Practice Address - Street 2:STE 306
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3565
Practice Address - Country:US
Practice Address - Phone:830-608-1403
Practice Address - Fax:830-608-1400
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX01112171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX27-0219010OtherFEDERAL BUSINESS ID