Provider Demographics
NPI:1114512324
Name:MILLER, CYNDI LOU (LPN, ASN, ADN)
Entity Type:Individual
Prefix:MRS
First Name:CYNDI
Middle Name:LOU
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPN, ASN, ADN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471688 HIGHWAY 51
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-4490
Mailing Address - Country:US
Mailing Address - Phone:918-696-8826
Mailing Address - Fax:918-696-8840
Practice Address - Street 1:82022 S 4739 RD
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-5253
Practice Address - Country:US
Practice Address - Phone:918-575-5991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0035627164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse