Provider Demographics
NPI:1154681187
Name:MILLER, JASON RONALD (LPN)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:RONALD
Last Name:MILLER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11309 NE 359TH ST
Mailing Address - Street 2:
Mailing Address - City:LA CENTER
Mailing Address - State:WA
Mailing Address - Zip Code:98629-3643
Mailing Address - Country:US
Mailing Address - Phone:360-907-2782
Mailing Address - Fax:360-263-6544
Practice Address - Street 1:11309 NE 359TH ST
Practice Address - Street 2:
Practice Address - City:LA CENTER
Practice Address - State:WA
Practice Address - Zip Code:98629-3643
Practice Address - Country:US
Practice Address - Phone:360-907-2782
Practice Address - Fax:360-263-6544
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60272616164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse