Provider Demographics
NPI:1700399748
Name:MILLER, TRIEAS RENETTA
Entity Type:Individual
Prefix:MS
First Name:TRIEAS
Middle Name:RENETTA
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 1:9360 AMESBURY AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-4801
Mailing Address - Country:US
Mailing Address - Phone:216-862-7185
Mailing Address - Fax:
Practice Address - Street 1:9360 AMESBURY AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-4801
Practice Address - Country:US
Practice Address - Phone:216-450-8588
Practice Address - Fax:216-450-8588
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401360300312376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty