Provider Demographics
NPI:1780749366
Name:MILLER, SANDRA LAVERNE (APRN)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LAVERNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 RED CLOUD DR
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-7402
Mailing Address - Country:US
Mailing Address - Phone:254-690-6911
Mailing Address - Fax:254-690-6911
Practice Address - Street 1:603 RED CLOUD DR
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-7402
Practice Address - Country:US
Practice Address - Phone:254-690-6911
Practice Address - Fax:254-690-6911
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256587363LP0200X
CANP 14078363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics