Provider Demographics
NPI:1811464894
Name:MILLLER, NERISSA
Entity type:Individual
Prefix:
First Name:NERISSA
Middle Name:
Last Name:MILLLER
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 1:1140 NORTH CAPITOL STREET NW
Mailing Address - Street 2:419
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002
Mailing Address - Country:US
Mailing Address - Phone:202-215-9155
Mailing Address - Fax:
Practice Address - Street 1:1140 NORTH CAPITOL STREET NW
Practice Address - Street 2:419
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2000
Practice Address - Country:US
Practice Address - Phone:202-215-9155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant