Provider Demographics
NPI:1629215744
Name:MILLER, ANGELA CICERO (RN)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:CICERO
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 RYAN CT
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-1935
Mailing Address - Country:US
Mailing Address - Phone:631-821-3212
Mailing Address - Fax:
Practice Address - Street 1:7 RYAN CT
Practice Address - Street 2:
Practice Address - City:RIDGE
Practice Address - State:NY
Practice Address - Zip Code:11961-1935
Practice Address - Country:US
Practice Address - Phone:631-821-3212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY590595-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse