Provider Demographics
NPI:1093591158
Name:MILLER, CLAUDE HENRY IV (RN)
Entity Type:Individual
Prefix:
First Name:CLAUDE
Middle Name:HENRY
Last Name:MILLER
Suffix:IV
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2458 NEWPORT BLVD # 167
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1316
Mailing Address - Country:US
Mailing Address - Phone:248-444-6058
Mailing Address - Fax:
Practice Address - Street 1:4504 PEBBLE BROOK LN
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7215
Practice Address - Country:US
Practice Address - Phone:248-444-6058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95207924163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse