Provider Demographics
NPI:1376023556
Name:MILES, JANNA REBECCA (LVN)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:REBECCA
Last Name:MILES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 6TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEEN CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75572-2295
Mailing Address - Country:US
Mailing Address - Phone:903-490-1258
Mailing Address - Fax:
Practice Address - Street 1:309 6TH ST
Practice Address - Street 2:
Practice Address - City:QUEEN CITY
Practice Address - State:TX
Practice Address - Zip Code:75572-2295
Practice Address - Country:US
Practice Address - Phone:903-490-1258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX234018164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse