Basic Information
Provider Information | |||||||||
NPI: | 1225587223 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MILLER | ||||||||
FirstName: | EMILY | ||||||||
MiddleName: | PAIGE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | R.N. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SHARP | ||||||||
OtherFirstName: | EMILY | ||||||||
OtherMiddleName: | PAIGE | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | R.N. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1701 TOWNE CROSSING BLVD | ||||||||
Address2: | APT 1333 | ||||||||
City: | MANSFIELD | ||||||||
State: | TX | ||||||||
PostalCode: | 760633975 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6014985383 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1802 HIGHWAY 157 N | ||||||||
Address2: |   | ||||||||
City: | MANSFIELD | ||||||||
State: | TX | ||||||||
PostalCode: | 760633923 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8174736101 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/02/2016 | ||||||||
LastUpdateDate: | 10/02/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 865424 | TX | Y |   | Nursing Service Providers | Registered Nurse |   |
No ID Information.