Provider Demographics
NPI:1982922761
Name:MILLER, MARSHA ELAINE (LPN)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:ELAINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4487 TWP RD 66
Mailing Address - Street 2:
Mailing Address - City:CARDINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43315
Mailing Address - Country:US
Mailing Address - Phone:419-560-2566
Mailing Address - Fax:
Practice Address - Street 1:4487 TOWNSHIP ROAD 66
Practice Address - Street 2:
Practice Address - City:CARDINGTON
Practice Address - State:OH
Practice Address - Zip Code:43315-9565
Practice Address - Country:US
Practice Address - Phone:419-560-2566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 122728 MED IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse