Provider Demographics
NPI:1568141869
Name:MILLER, HOLLY (RDN, LD)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7608 STATE ROUTE 39
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-9014
Mailing Address - Country:US
Mailing Address - Phone:330-674-8370
Mailing Address - Fax:
Practice Address - Street 1:4748 OLDE PUMP STREET
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:OH
Practice Address - Zip Code:44687
Practice Address - Country:US
Practice Address - Phone:330-893-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2757133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered