Provider Demographics
NPI:1396377123
Name:MILLER, MARY ANGELA (RDN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANGELA
Last Name:MILLER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 JACOB CLOSE
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2884
Mailing Address - Country:US
Mailing Address - Phone:614-620-0459
Mailing Address - Fax:
Practice Address - Street 1:560 JACOB CLOSE
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2884
Practice Address - Country:US
Practice Address - Phone:614-620-0459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH313133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered