Provider Demographics
NPI:1396939294
Name:MILES, DENA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:MARIE
Last Name:MILES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 9TH AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-2014
Mailing Address - Country:US
Mailing Address - Phone:814-943-7546
Mailing Address - Fax:814-943-7543
Practice Address - Street 1:2525 9TH AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2014
Practice Address - Country:US
Practice Address - Phone:814-943-7546
Practice Address - Fax:814-943-7543
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2025-02-25
Deactivation Date:2014-10-20
Deactivation Code:
Reactivation Date:2014-12-31
Provider Licenses
StateLicense IDTaxonomies
PAMA053008174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist