Provider Demographics
NPI:1881970945
Name:MILLER, BEVERLY ANN (PRACTICAL NURSE)
Entity type:Individual
Prefix:MISS
First Name:BEVERLY
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PRACTICAL NURSE
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 184
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:IN
Mailing Address - Zip Code:47874-0184
Mailing Address - Country:US
Mailing Address - Phone:765-832-1978
Mailing Address - Fax:
Practice Address - Street 1:810 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IN
Practice Address - Zip Code:47842-2220
Practice Address - Country:US
Practice Address - Phone:765-832-1978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27031347A164W00000X
HI11675164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse