Provider Demographics
NPI:1760913990
Name:MILLER, CAROLYN ANN (RN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
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 1:14700 NORTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44062-9009
Mailing Address - Country:US
Mailing Address - Phone:440-313-4598
Mailing Address - Fax:440-632-9750
Practice Address - Street 1:14700 NORTHVIEW DR
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:OH
Practice Address - Zip Code:44062-9009
Practice Address - Country:US
Practice Address - Phone:440-313-4598
Practice Address - Fax:440-632-9750
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN376551163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse