Provider Demographics
NPI:1558070987
Name:MILLER, CORRIE (LPN)
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ROUSCH DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-3872
Mailing Address - Country:US
Mailing Address - Phone:304-598-6099
Mailing Address - Fax:304-974-3006
Practice Address - Street 1:12 ROUSCH DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-3872
Practice Address - Country:US
Practice Address - Phone:304-598-6099
Practice Address - Fax:304-974-3006
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV29801172V00000X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No172V00000XOther Service ProvidersCommunity Health Worker