Provider Demographics
NPI:1235819152
Name:MILLER, JONATHAN LAMAR (RN)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:LAMAR
Last Name:MILLER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 CHRISTIANS TEE
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78108-2401
Mailing Address - Country:US
Mailing Address - Phone:180-320-1765
Mailing Address - Fax:
Practice Address - Street 1:3129 CHRISTIANS TEE
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78108-2401
Practice Address - Country:US
Practice Address - Phone:180-320-1765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX879407163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency