Provider Demographics
NPI:1134631971
Name:MILLER, VICTORIA L (NURSE)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:ME
Mailing Address - Zip Code:04551-3012
Mailing Address - Country:US
Mailing Address - Phone:979-229-9661
Mailing Address - Fax:
Practice Address - Street 1:8 MAPLE LN
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:ME
Practice Address - Zip Code:04551-3012
Practice Address - Country:US
Practice Address - Phone:979-229-9661
Practice Address - Fax:207-529-2261
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER032738163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse