Basic Information
| Provider Information | |||||||||
| NPI: | 1194941781 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | JAYME | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2601 CHERRY AVE | ||||||||
| Address2: | STE 115 | ||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983104214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603773911 | ||||||||
| FaxNumber: | 3604758530 | ||||||||
| Practice Location | |||||||||
| Address1: | 2520 CHERRY AVE | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983104229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603773911 | ||||||||
| FaxNumber: | 3604758530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | DI00001722 | WA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.