Provider Demographics
NPI:1497527378
Name:MILLER, JENNA NOEL
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:NOEL
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 1:608 E PITT ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-9723
Mailing Address - Country:US
Mailing Address - Phone:814-624-3121
Mailing Address - Fax:814-266-2880
Practice Address - Street 1:608 E PITT ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-9723
Practice Address - Country:US
Practice Address - Phone:814-624-3121
Practice Address - Fax:814-266-2880
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN293209164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse