Provider Demographics
NPI:1376733550
Name:MILLER, ERIC DAVID (CN)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:DAVID
Last Name:MILLER
Suffix:
Gender:M
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 4TH AVE E
Mailing Address - Street 2:SUITE 507
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6983
Mailing Address - Country:US
Mailing Address - Phone:360-292-2159
Mailing Address - Fax:866-870-3866
Practice Address - Street 1:203 4TH AVE E
Practice Address - Street 2:SUITE 507
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-6983
Practice Address - Country:US
Practice Address - Phone:360-292-2159
Practice Address - Fax:866-870-3866
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU00001784133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist