Basic Information
| Provider Information | |||||||||
| NPI: | 1609327360 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | ELLEN | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 429 | ||||||||
| Address2: | |||||||||
| City: | LISBON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444320429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304249573 | ||||||||
| FaxNumber: | 3304240877 | ||||||||
| Practice Location | |||||||||
| Address1: | 40722 STATE ROUTE 154 | ||||||||
| Address2: | |||||||||
| City: | LISBON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444328500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304249573 | ||||||||
| FaxNumber: | 3304240877 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2016 | ||||||||
| LastUpdateDate: | 10/18/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | LPN 044148 | OH | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.