Provider Demographics
NPI:1669685459
Name:MILLER, PATRICIA J
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
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 1:1151 NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-7564
Mailing Address - Country:US
Mailing Address - Phone:330-825-7960
Mailing Address - Fax:330-825-7960
Practice Address - Street 1:1151 NOBLE AVE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-7564
Practice Address - Country:US
Practice Address - Phone:330-825-7960
Practice Address - Fax:330-825-7960
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2343600Medicaid