Provider Demographics
NPI:1326713199
Name:MILLER, LONNIE EUGENE (RN, CNOR, VA-BC)
Entity Type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:EUGENE
Last Name:MILLER
Suffix:
Gender:M
Credentials:RN, CNOR, VA-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43396 KINGSTON LYONS DR SE
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-9733
Mailing Address - Country:US
Mailing Address - Phone:503-507-0999
Mailing Address - Fax:
Practice Address - Street 1:1401 N 10TH AVE
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-1399
Practice Address - Country:US
Practice Address - Phone:503-769-9322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201040619RN163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator