Provider Demographics
NPI:1780701011
Name:MILLER, CAROLYN (RN)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7137
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39506-7137
Mailing Address - Country:US
Mailing Address - Phone:228-248-2480
Mailing Address - Fax:228-248-2484
Practice Address - Street 1:2781 C T SWITZER SR DR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4536
Practice Address - Country:US
Practice Address - Phone:228-248-2480
Practice Address - Fax:228-248-2484
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR696056163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse