Provider Demographics
NPI:1750682449
Name:MILLER, JENNIE EMI (RN,HN-BC, ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:EMI
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN,HN-BC, ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 EAST BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5707
Practice Address - Country:US
Practice Address - Phone:704-332-1207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACU-1171100000X
NC102564364SH1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SH1100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHolistic
No171100000XOther Service ProvidersAcupuncturist