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Individual
SHANNON RAQUEL MILES
Active
Individual
SHANNON RAQUEL MILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
165853
AZ
363LF0000X
Family Nurse Practitioner
Primary
235897
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
235897
AZ
Other
Enumeration date
07/03/2019
Last updated
12/21/2020
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