Provider Demographics
NPI:1235542770
Name:MILLER, JACKIE ELAINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:ELAINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 CANTON RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-4074
Mailing Address - Country:US
Mailing Address - Phone:330-798-1002
Mailing Address - Fax:330-798-1162
Practice Address - Street 1:1880 CANTON RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-4074
Practice Address - Country:US
Practice Address - Phone:330-798-1002
Practice Address - Fax:330-798-1162
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN34766163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool