Provider Demographics
NPI:1033883962
Name:MILLER, CHYNNAH MONEA-MARIE
Entity Type:Individual
Prefix:
First Name:CHYNNAH
Middle Name:MONEA-MARIE
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 1:1910 49TH ST S APT 16
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-7757
Mailing Address - Country:US
Mailing Address - Phone:701-640-6834
Mailing Address - Fax:
Practice Address - Street 1:1910 49TH ST S APT 16
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-7757
Practice Address - Country:US
Practice Address - Phone:701-640-6834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant