Provider Demographics
NPI:1740996065
Name:MILLER, JAMESETTA KAIDDY
Entity type:Individual
Prefix:
First Name:JAMESETTA
Middle Name:KAIDDY
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 1:1104 JEFFERSON PL
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02019-1368
Mailing Address - Country:US
Mailing Address - Phone:702-960-8706
Mailing Address - Fax:
Practice Address - Street 1:1104 JEFFERSON PL
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02019-1368
Practice Address - Country:US
Practice Address - Phone:702-960-8706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1006783747P1801X
ND1006783747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant