Provider Demographics
NPI:1164225116
Name:MILLER, SHARRIE IRENE (LVN)
Entity type:Individual
Prefix:
First Name:SHARRIE
Middle Name:IRENE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:SHARRIE
Other - Middle Name:IRENE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:329 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4405
Mailing Address - Country:US
Mailing Address - Phone:707-828-1705
Mailing Address - Fax:
Practice Address - Street 1:329 N MAIN ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4405
Practice Address - Country:US
Practice Address - Phone:707-828-1705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207521164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA222Medicaid