Provider Demographics
NPI:1689338014
Name:MILLER, ANTRONETTE (LPN)
Entity Type:Individual
Prefix:
First Name:ANTRONETTE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 N SCOTTSDALE RD STE D
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-4207
Mailing Address - Country:US
Mailing Address - Phone:480-867-0999
Mailing Address - Fax:
Practice Address - Street 1:617 N SCOTTSDALE RD STE D
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-4207
Practice Address - Country:US
Practice Address - Phone:480-867-0999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ241036164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty