Provider Demographics
NPI:1679768717
Name:BRIGHT, MILES MANDEL (LVN)
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:MANDEL
Last Name:BRIGHT
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 CATTAIL CIR
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-2654
Mailing Address - Country:US
Mailing Address - Phone:254-634-0287
Mailing Address - Fax:
Practice Address - Street 1:412 CATTAIL CIR
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-2654
Practice Address - Country:US
Practice Address - Phone:254-634-0287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX173705164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse