Provider Demographics
NPI:1275982928
Name:MILLER, MELISSA M I (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:MILLER
Suffix:I
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 1:26 MYRTLE LN
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-3146
Mailing Address - Country:US
Mailing Address - Phone:631-566-7928
Mailing Address - Fax:
Practice Address - Street 1:26 MYRTLE LN
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-3146
Practice Address - Country:US
Practice Address - Phone:631-566-7928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY694402-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse