Provider Demographics
NPI:1861550808
Name:MILLER, ROBERT EDWARD (RN)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EDWARD
Last Name:MILLER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6720 LINDA SUE WAY
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3024
Mailing Address - Country:US
Mailing Address - Phone:916-847-4570
Mailing Address - Fax:916-965-8956
Practice Address - Street 1:3230 PEACEKEEPER WAY BLDG 209
Practice Address - Street 2:
Practice Address - City:MCCLELLAN
Practice Address - State:CA
Practice Address - Zip Code:95652-2600
Practice Address - Country:US
Practice Address - Phone:916-830-1526
Practice Address - Fax:916-929-1861
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA560859163WC0200X, 163WC0400X, 163WC1600X, 163WE0003X, 163WF0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Not Answered163WC0400XNursing Service ProvidersRegistered NurseCase Management
Not Answered163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
Not Answered163WE0003XNursing Service ProvidersRegistered NurseEmergency
Not Answered163WF0300XNursing Service ProvidersRegistered NurseFlight