Provider Demographics
NPI:1982888921
Name:MILLER, WILLIAM LAVANT (LPN)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:LAVANT
Last Name:MILLER
Suffix:
Gender:M
Credentials:LPN
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 523
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44068-0523
Mailing Address - Country:US
Mailing Address - Phone:440-224-2480
Mailing Address - Fax:775-908-5339
Practice Address - Street 1:6329 GREEN ROAD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44068-0523
Practice Address - Country:US
Practice Address - Phone:440-224-2480
Practice Address - Fax:775-908-5339
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
OH127712164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse