Provider Demographics
NPI:1841474848
Name:MILLER, PRISCILLA JEAN (CHAIV)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:JEAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:CHAIV
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 9
Mailing Address - Street 2:
Mailing Address - City:KING COVE
Mailing Address - State:AK
Mailing Address - Zip Code:99612-0009
Mailing Address - Country:US
Mailing Address - Phone:907-492-2311
Mailing Address - Fax:907-497-2310
Practice Address - Street 1:101 SLOCUM DRIVE
Practice Address - Street 2:
Practice Address - City:KING COVE
Practice Address - State:AK
Practice Address - Zip Code:99612-0009
Practice Address - Country:US
Practice Address - Phone:907-492-2311
Practice Address - Fax:907-497-2310
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist