Provider Demographics
NPI:1841892346
Name:MILLER, GLEN ALAN
Entity type:Individual
Prefix:
First Name:GLEN
Middle Name:ALAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2643 RIVERCHASE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-2573
Mailing Address - Country:US
Mailing Address - Phone:614-935-9201
Mailing Address - Fax:
Practice Address - Street 1:2643 RIVERCHASE DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-2573
Practice Address - Country:US
Practice Address - Phone:614-935-9201
Practice Address - Fax:513-217-0870
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider