Provider Demographics
NPI:1689817876
Name:MILLER, MICHELLE DIANE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DIANE
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 1:1337 ISLAND TREES LN
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-0816
Mailing Address - Country:US
Mailing Address - Phone:386-479-7650
Mailing Address - Fax:386-624-7206
Practice Address - Street 1:1337 ISLAND TREES LN
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-0816
Practice Address - Country:US
Practice Address - Phone:386-479-7650
Practice Address - Fax:386-624-7206
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath