Provider Demographics
NPI:1962045799
Name:MILLER, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MILLER
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 1:1750 ALDER BEND RD
Mailing Address - Street 2:
Mailing Address - City:ALTONA
Mailing Address - State:NY
Mailing Address - Zip Code:12910
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1750 ALDER BEND RD
Practice Address - Street 2:
Practice Address - City:ALTONA
Practice Address - State:NY
Practice Address - Zip Code:12910
Practice Address - Country:US
Practice Address - Phone:518-236-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider