Provider Demographics
NPI:1407270713
Name:MILES, DIMITRI
Entity Type:Individual
Prefix:
First Name:DIMITRI
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 3RD ST SE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-3012
Mailing Address - Country:US
Mailing Address - Phone:330-453-6012
Mailing Address - Fax:330-453-5096
Practice Address - Street 1:1824 3RD ST SE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-3012
Practice Address - Country:US
Practice Address - Phone:330-453-6012
Practice Address - Fax:330-453-5096
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN220223163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool