Provider Demographics
NPI:1760682652
Name:MILLER, MARION BERNICE (RN)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:BERNICE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 ARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-1118
Mailing Address - Country:US
Mailing Address - Phone:219-883-2211
Mailing Address - Fax:
Practice Address - Street 1:260 ARTHUR ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-1118
Practice Address - Country:US
Practice Address - Phone:219-883-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28112066A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse