Provider Demographics
NPI:1801686506
Name:MILLER, ANISSA R
Entity type:Individual
Prefix:
First Name:ANISSA
Middle Name:R
Last Name:MILLER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ANISSA
Other - Middle Name:R
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4519 WIRT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-4504
Mailing Address - Country:US
Mailing Address - Phone:402-812-4424
Mailing Address - Fax:
Practice Address - Street 1:4519 WIRT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-4504
Practice Address - Country:US
Practice Address - Phone:402-812-4424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant