Provider Demographics
NPI:1104071117
Name:MILLER, DONALD LEROY (BSN, RN)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:LEROY
Last Name:MILLER
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 NW 45TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-4612
Mailing Address - Country:US
Mailing Address - Phone:816-455-3400
Mailing Address - Fax:816-455-2248
Practice Address - Street 1:851 NW 45TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-4612
Practice Address - Country:US
Practice Address - Phone:816-455-3400
Practice Address - Fax:816-455-2248
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-80206-071163W00000X
MO148495163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse