Provider Demographics
NPI:1073108031
Name:MILLER, CONNIE J
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:J
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 1:2611 N MAIN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-4084
Mailing Address - Country:US
Mailing Address - Phone:419-957-4005
Mailing Address - Fax:
Practice Address - Street 1:2611 N MAIN ST APT 1
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-4084
Practice Address - Country:US
Practice Address - Phone:419-957-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker