Provider Demographics
NPI:1710439336
Name:MILLER, MARLENE MARIE X
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:MARIE
Last Name:MILLER
Suffix:X
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 1:14328 ELSETTA AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-2031
Mailing Address - Country:US
Mailing Address - Phone:216-671-7892
Mailing Address - Fax:
Practice Address - Street 1:14328 ELSETTA AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-2031
Practice Address - Country:US
Practice Address - Phone:216-671-7892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0182088Medicaid