Provider Demographics
NPI:1487852877
Name:MILES, CONSTANCE IHA (LM CPM RN)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:IHA
Last Name:MILES
Suffix:
Gender:F
Credentials:LM CPM RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14377 MORELLI LANE
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472
Mailing Address - Country:US
Mailing Address - Phone:707-874-2888
Mailing Address - Fax:707-874-2888
Practice Address - Street 1:14377 MORELLI LANE
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472
Practice Address - Country:US
Practice Address - Phone:707-874-2888
Practice Address - Fax:707-874-2888
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM55176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife