Basic Information
| Provider Information | |||||||||
| NPI: | 1003141680 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILES | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | CRNA, RN, BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 713 W VIRGINIA AVE | ||||||||
| Address2: | |||||||||
| City: | DUNBAR | ||||||||
| State: | WV | ||||||||
| PostalCode: | 250643219 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 MORRIS ST | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253011326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043885432 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2009 | ||||||||
| LastUpdateDate: | 10/15/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 50874 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.