Provider Demographics
NPI:1619509668
Name:MILLER, REBECCA JEAN
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEAN
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 1:429 HIGHLAND MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617-3375
Mailing Address - Country:US
Mailing Address - Phone:423-967-5419
Mailing Address - Fax:
Practice Address - Street 1:429 HIGHLAND MEADOWS DR
Practice Address - Street 2:
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617-3375
Practice Address - Country:US
Practice Address - Phone:423-967-5419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider