Provider Demographics
NPI:1518559160
Name:MILLER, LEEAH E (BSN,RN)
Entity Type:Individual
Prefix:
First Name:LEEAH
Middle Name:E
Last Name:MILLER
Suffix:
Gender:F
Credentials:BSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 UPPER DARBY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-4652
Mailing Address - Country:US
Mailing Address - Phone:504-606-4222
Mailing Address - Fax:
Practice Address - Street 1:605 UPPER DARBY RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-4652
Practice Address - Country:US
Practice Address - Phone:504-606-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906344163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse