Provider Demographics
NPI:1376892661
Name:MILLER, PATRICIA (LPN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 LINDEN BLVD
Mailing Address - Street 2:APT 5B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-5156
Mailing Address - Country:US
Mailing Address - Phone:347-663-2433
Mailing Address - Fax:
Practice Address - Street 1:1415 LINDEN BLVD
Practice Address - Street 2:APT 5B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5156
Practice Address - Country:US
Practice Address - Phone:347-663-2433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-03
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234928164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse