Provider Demographics
NPI:1154659571
Name:MILLER, BONNIE LEWIS (RN BSN)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:LEWIS
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 1:16703 ASHTON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-4144
Mailing Address - Country:US
Mailing Address - Phone:313-538-7222
Mailing Address - Fax:
Practice Address - Street 1:16703 ASHTON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-4144
Practice Address - Country:US
Practice Address - Phone:313-538-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704073195163WW0101X, 174H00000X, 163WL0100X, 163W00000X, 163WM0102X, 163WN0003X, 163WP1700X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No174H00000XOther Service ProvidersHealth Educator
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk
No163WP1700XNursing Service ProvidersRegistered NursePerinatal
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704073195OtherREGISTERED NURSE LICENSE NUMBER