Provider Demographics
NPI:1164028312
Name:MILLER, MARVA RENEE (RMA, HSA)
Entity Type:Individual
Prefix:
First Name:MARVA
Middle Name:RENEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RMA, HSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 KOEHLER AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-4845
Mailing Address - Country:US
Mailing Address - Phone:513-226-4757
Mailing Address - Fax:
Practice Address - Street 1:110 KOEHLER AVE APT 10
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-4845
Practice Address - Country:US
Practice Address - Phone:513-226-4757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH322217280412376K00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide