Provider Demographics
NPI:1720832066
Name:CORE MILLER, MICHELINE
Entity Type:Individual
Prefix:
First Name:MICHELINE
Middle Name:
Last Name:CORE 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 1:715 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-2414
Mailing Address - Country:US
Mailing Address - Phone:330-839-3125
Mailing Address - Fax:
Practice Address - Street 1:715 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2414
Practice Address - Country:US
Practice Address - Phone:330-839-3125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No347C00000XTransportation ServicesPrivate Vehicle