Provider Demographics
NPI:1073275798
Name:MILES, LORNA DEAN (CHW, MRSS-P, MAADCII)
Entity type:Individual
Prefix:MRS
First Name:LORNA
Middle Name:DEAN
Last Name:MILES
Suffix:
Gender:F
Credentials:CHW, MRSS-P, MAADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 SILVA LN APT 33
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-3615
Mailing Address - Country:US
Mailing Address - Phone:660-998-4307
Mailing Address - Fax:660-263-7244
Practice Address - Street 1:2251 SILVA LN APT 33
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-3615
Practice Address - Country:US
Practice Address - Phone:660-998-4307
Practice Address - Fax:660-263-7244
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO171M00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator