Provider Demographics
NPI:1629195839
Name:MILLER, JUSTINA CAROLE (RN)
Entity Type:Individual
Prefix:MS
First Name:JUSTINA
Middle Name:CAROLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:267 SUMPTION DR
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1639
Mailing Address - Country:US
Mailing Address - Phone:614-507-0851
Mailing Address - Fax:614-476-4933
Practice Address - Street 1:267 SUMPTION DR
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1639
Practice Address - Country:US
Practice Address - Phone:614-507-0851
Practice Address - Fax:614-476-4933
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHRN 106892163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2482540Medicaid