Provider Demographics
NPI:1366113417
Name:MILLER, KRISTIE S (RN)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:S
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2838 W 9760 S
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3250
Mailing Address - Country:US
Mailing Address - Phone:801-671-2462
Mailing Address - Fax:801-447-2521
Practice Address - Street 1:2838 W 9760 S
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3250
Practice Address - Country:US
Practice Address - Phone:801-671-2462
Practice Address - Fax:801-446-2521
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT273124-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse