Provider Demographics
NPI:1699358812
Name:MILEY, THEODORE JR (LPN)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:MILEY
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NORTHVIEW PLZ
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3173
Mailing Address - Country:US
Mailing Address - Phone:336-818-0607
Mailing Address - Fax:
Practice Address - Street 1:200 NORTHVIEW PLZ
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3173
Practice Address - Country:US
Practice Address - Phone:336-818-0607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC75052164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse