Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | AP30004340 | WA |
NPI | 1891753455 |
---|---|
Provider Name | Carol Miller |
First Address | Spokane Valley, WA 99216-0413 |
Second Address | Spokane, WA 99205-1349 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9622853 | (05) | WA |
S91669 | (02) | WA |