Provider Demographics
NPI:1821608001
Name:MILES, ELIZABETH C (LPN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:MILES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6173 WHITETAIL RUN
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD VLG
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3187
Mailing Address - Country:US
Mailing Address - Phone:216-630-5582
Mailing Address - Fax:
Practice Address - Street 1:6173 WHITETAIL RUN
Practice Address - Street 2:
Practice Address - City:OAKWOOD VLG
Practice Address - State:OH
Practice Address - Zip Code:44146-3187
Practice Address - Country:US
Practice Address - Phone:216-630-5582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH164200164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse