Provider Demographics
NPI:1043509292
Name:MILLER, JENNIFER SUE (RD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SUE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1449
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-1449
Mailing Address - Country:US
Mailing Address - Phone:804-435-8239
Mailing Address - Fax:804-435-0467
Practice Address - Street 1:101 HARRIS RD
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-3880
Practice Address - Country:US
Practice Address - Phone:804-435-8239
Practice Address - Fax:804-435-0467
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered