Provider Demographics
NPI:1083360192
Name:MILLIEN, MIRIAM VERONIQUE (RN)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:VERONIQUE
Last Name:MILLIEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 HERON LN
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2464
Mailing Address - Country:US
Mailing Address - Phone:917-685-9961
Mailing Address - Fax:
Practice Address - Street 1:163 W 125TH ST FL 12
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4436
Practice Address - Country:US
Practice Address - Phone:212-961-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY508729163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse