Provider Demographics
NPI:1952693608
Name:MILLER, JENNIFER ANN
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:N8552 970TH ST
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:WI
Mailing Address - Zip Code:54730-5114
Mailing Address - Country:US
Mailing Address - Phone:402-238-5875
Mailing Address - Fax:
Practice Address - Street 1:1810 4TH AVE
Practice Address - Street 2:APT #5
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-5135
Practice Address - Country:US
Practice Address - Phone:715-684-4655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI174895-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse