Provider Demographics
NPI:1295867885
Name:MILLER, JEANNIE RENE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:RENE
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 1:6595 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FRAZEYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43822-9549
Mailing Address - Country:US
Mailing Address - Phone:740-349-8454
Mailing Address - Fax:
Practice Address - Street 1:6595 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:FRAZEYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43822-9549
Practice Address - Country:US
Practice Address - Phone:740-349-8454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH203841163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2241005Medicaid