Provider Demographics
NPI:1083074512
Name:MILLER, BETH (RN, BSN)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 SW MT RAINIER ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-5551
Mailing Address - Country:US
Mailing Address - Phone:503-474-4937
Mailing Address - Fax:
Practice Address - Street 1:411 SW MT RAINIER ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-5551
Practice Address - Country:US
Practice Address - Phone:503-474-4937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200541060RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health