Provider Demographics
NPI:1700031523
Name:MILLER, ANGELA YVONNE
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:YVONNE
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 1:9261 SHADY LAKE DR
Mailing Address - Street 2:G204
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-5279
Mailing Address - Country:US
Mailing Address - Phone:330-626-3737
Mailing Address - Fax:330-626-3737
Practice Address - Street 1:9261 SHADY LAKE DR
Practice Address - Street 2:G204
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5279
Practice Address - Country:US
Practice Address - Phone:330-626-3737
Practice Address - Fax:330-626-3737
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150935343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)