Provider Demographics
NPI:1952344699
Name:MILLER, SANDRA L (CNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 CATHEDRAL DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6018
Mailing Address - Country:US
Mailing Address - Phone:605-343-9224
Mailing Address - Fax:605-342-1359
Practice Address - Street 1:636 SAINT ANNE ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4694
Practice Address - Country:US
Practice Address - Phone:605-348-8000
Practice Address - Fax:605-348-4315
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR0148350250363LF0000X, 363LX0001X
SDCP000250363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6826173Medicaid
SD6826173Medicaid
SDS104256Medicare PIN