Provider Demographics
NPI:1902023443
Name:MILLER, REBECCA (RN)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
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 1:28564 CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:HANOVERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44423-9779
Mailing Address - Country:US
Mailing Address - Phone:330-223-2234
Mailing Address - Fax:
Practice Address - Street 1:28564 CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:HANOVERTON
Practice Address - State:OH
Practice Address - Zip Code:44423-9779
Practice Address - Country:US
Practice Address - Phone:330-223-2234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN326989163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN326989OtherREGISTERED NURSE