Provider Demographics
NPI:1568788032
Name:MILLER, WENDY EILEEN (LVN)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:EILEEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S WALNUT
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:TX
Mailing Address - Zip Code:76660-3007
Mailing Address - Country:US
Mailing Address - Phone:254-533-2484
Mailing Address - Fax:
Practice Address - Street 1:420 S WALNUT
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:TX
Practice Address - Zip Code:76660-3007
Practice Address - Country:US
Practice Address - Phone:254-533-2484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227273164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse