Individual
CAROL W MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2300 E 30TH ST BLDG D, STE 101, FARMINGTON, NM 87401-8990
(505) 327-1400
(505) 566-3202
Mailing address
2300 E 30TH ST BLDG D, STE 101, FARMINGTON, NM 87401-8990
(505) 327-1400
(505) 566-3202
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA2004-0032
NM
363AS0400X
Surgical Physician Assistant
PA2004-0032
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
52889718
—
NM
Enumeration date
12/15/2006
Last updated
04/15/2016
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