Provider Demographics
NPI:1245435262
Name:MILLER, LISA JANE
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JANE
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:PO BOX 195
Mailing Address - Street 2:137 JONES CIRCLE
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44627
Mailing Address - Country:US
Mailing Address - Phone:330-695-9311
Mailing Address - Fax:
Practice Address - Street 1:4639 E MORELAND RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:OH
Practice Address - Zip Code:44627
Practice Address - Country:US
Practice Address - Phone:330-698-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2470991Medicaid