Provider Demographics
NPI:1700326311
Name:MILLER, PAMELA ELAINE
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ELAINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:ELAINE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARRT (R) (M)
Mailing Address - Street 1:842 N HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-2928
Mailing Address - Country:US
Mailing Address - Phone:928-697-4311
Mailing Address - Fax:928-697-4107
Practice Address - Street 1:842 N HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-2928
Practice Address - Country:US
Practice Address - Phone:928-697-4311
Practice Address - Fax:928-697-4107
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2697372471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography