Provider Demographics
NPI:1467056259
Name:MILLER, TANYA
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:MILLER
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:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:NEW STRAITSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43766-0055
Mailing Address - Country:US
Mailing Address - Phone:740-243-8074
Mailing Address - Fax:
Practice Address - Street 1:108 BALL ST, NEW STRAITSVILLE OH
Practice Address - Street 2:
Practice Address - City:NEW STRAITSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43766
Practice Address - Country:US
Practice Address - Phone:740-243-8074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide