Provider Demographics
NPI:1780956656
Name:MILLER, JENNIFER (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
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 1:305 E PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:LANARK
Mailing Address - State:IL
Mailing Address - Zip Code:61046-1336
Mailing Address - Country:US
Mailing Address - Phone:815-244-8855
Mailing Address - Fax:815-244-5010
Practice Address - Street 1:822 S MILL ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARROLL
Practice Address - State:IL
Practice Address - Zip Code:61053-1243
Practice Address - Country:US
Practice Address - Phone:815-244-8855
Practice Address - Fax:815-244-5010
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.304081163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health