Provider Demographics
NPI:1467646802
Name:MILES, WILLIE B (LPN)
Entity type:Individual
Prefix:MRS
First Name:WILLIE
Middle Name:B
Last Name:MILES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:WILLIE
Other - Middle Name:B
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7630 MERRITT DRIVE
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027
Mailing Address - Country:US
Mailing Address - Phone:315-450-3077
Mailing Address - Fax:
Practice Address - Street 1:25 CHAUCER CIRCLE
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027
Practice Address - Country:US
Practice Address - Phone:315-450-3077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095618 1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse