Provider Demographics
NPI:1639422371
Name:MILLER, GARY CURTIS (LPN, CMA, CN)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:CURTIS
Last Name:MILLER
Suffix:
Gender:M
Credentials:LPN, CMA, CN
Other - Prefix:MR
Other - First Name:GARY
Other - Middle Name:CURTIS
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN,CMA
Mailing Address - Street 1:102 S WEST ST
Mailing Address - Street 2:SUITE # 7
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-2857
Mailing Address - Country:US
Mailing Address - Phone:443-564-7894
Mailing Address - Fax:
Practice Address - Street 1:102 S WEST ST
Practice Address - Street 2:SUITE # 7
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-2857
Practice Address - Country:US
Practice Address - Phone:443-564-7894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN290986164W00000X
MDLP47744164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse