Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 006731 | AZ |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 006731 | AZ |
NPI | 1083841191 |
---|---|
Provider Name | Dr. Holly Kline Miller |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2009 |
Last Update Date | 25/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
023352 | (05) | AZ |