Provider Demographics
NPI:1003198870
Name:MILLER, REVA
Entity Type:Individual
Prefix:MRS
First Name:REVA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 NASSAU BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2852
Mailing Address - Country:US
Mailing Address - Phone:516-390-3165
Mailing Address - Fax:516-489-8946
Practice Address - Street 1:450 NASSAU BLVD
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2852
Practice Address - Country:US
Practice Address - Phone:516-390-3165
Practice Address - Fax:516-489-8946
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339399163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse