Provider Demographics
NPI:1235198904
Name:MILLER, JENNY (RN CLCP MSCC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN CLCP MSCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12313 N HOGAN RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IN
Mailing Address - Zip Code:47001-8016
Mailing Address - Country:US
Mailing Address - Phone:812-744-1045
Mailing Address - Fax:877-285-6536
Practice Address - Street 1:12313 N HOGAN RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IN
Practice Address - Zip Code:47001-8016
Practice Address - Country:US
Practice Address - Phone:812-744-1045
Practice Address - Fax:877-285-6536
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN243420163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2107008OtherINDEPENDENT MEDICAID PROV