Provider Demographics
NPI:1063557825
Name:MILLER, JENNIFER MICHELLE (RD, CNSD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RD, CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 LADY BANKS LN
Mailing Address - Street 2:UNIT 10 H
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-6413
Mailing Address - Country:US
Mailing Address - Phone:843-446-5680
Mailing Address - Fax:
Practice Address - Street 1:4070 HWY 17 BYPASS
Practice Address - Street 2:WACCAMAW COMMUNITY HOSPITAL JENNIFER MILLER
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-6413
Practice Address - Country:US
Practice Address - Phone:843-652-1841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC912341133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered