Provider Demographics
NPI:1023633989
Name:MILLER, ALYSSA HOPE
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:HOPE
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 1:38039 N PENINSULA RD
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-8157
Mailing Address - Country:US
Mailing Address - Phone:847-533-0297
Mailing Address - Fax:
Practice Address - Street 1:38039 N PENINSULA RD
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-8157
Practice Address - Country:US
Practice Address - Phone:847-533-0297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered