Provider Demographics
NPI:1811189020
Name:MIA, JANE F
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:F
Last Name:MIA
Suffix:
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 1:400 E 70TH ST
Mailing Address - Street 2:APT 606
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5387
Mailing Address - Country:US
Mailing Address - Phone:212-879-1149
Mailing Address - Fax:
Practice Address - Street 1:400 E 70TH ST
Practice Address - Street 2:APT 606
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5387
Practice Address - Country:US
Practice Address - Phone:212-879-1149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346749163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse