Provider Demographics
NPI:1396017042
Name:MILLER, DANIELETTE LEE (CST)
Entity Type:Individual
Prefix:
First Name:DANIELETTE
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:DANI
Other - Middle Name:LEE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CST
Mailing Address - Street 1:9 E BROKEN OAK CT
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-2725
Mailing Address - Country:US
Mailing Address - Phone:281-818-9009
Mailing Address - Fax:
Practice Address - Street 1:9 E BROKEN OAK CT
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-2725
Practice Address - Country:US
Practice Address - Phone:281-818-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122327246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist