Provider Demographics
NPI:1043868367
Name:MILES, C. SUNFLOWER (RN)
Entity type:Individual
Prefix:
First Name:C.
Middle Name:SUNFLOWER
Last Name:MILES
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 1:741 N COLONY SURF DR
Mailing Address - Street 2:
Mailing Address - City:LILLIWAUP
Mailing Address - State:WA
Mailing Address - Zip Code:98555-9782
Mailing Address - Country:US
Mailing Address - Phone:253-261-6961
Mailing Address - Fax:
Practice Address - Street 1:741 N COLONYSURF DR
Practice Address - Street 2:
Practice Address - City:LILLIWAUP
Practice Address - State:WA
Practice Address - Zip Code:98555-9855
Practice Address - Country:US
Practice Address - Phone:253-261-6961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60434991164W00000X
WARN612122141163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA604477393OtherUNIFORM BUSINESS NUMBER