Provider Demographics
NPI:1427489293
Name:MILLER, SHAUNA RENEE (PA)
Entity type:Individual
Prefix:MISS
First Name:SHAUNA
Middle Name:RENEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:225 E 5TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-1641
Mailing Address - Country:US
Mailing Address - Phone:810-406-4941
Mailing Address - Fax:810-234-7068
Practice Address - Street 1:G-3375 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529
Practice Address - Country:US
Practice Address - Phone:810-743-6830
Practice Address - Fax:810-234-7068
Is Sole Proprietor?:No
Enumeration Date:2013-12-04
Last Update Date:2019-02-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601006844363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant