Provider Demographics
NPI:1790153419
Name:MILLER, COURTNEY JEAN (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:JEAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1146 STACY DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1423
Mailing Address - Country:US
Mailing Address - Phone:517-745-6794
Mailing Address - Fax:
Practice Address - Street 1:1146 STACY DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-1423
Practice Address - Country:US
Practice Address - Phone:517-745-6794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704301228163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse