Provider Demographics
NPI:1104637206
Name:MILLER, CHAMPELLE CAPRI (CNA)
Entity type:Individual
Prefix:
First Name:CHAMPELLE
Middle Name:CAPRI
Last Name:MILLER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 ROOSEVELT ST NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-3327
Mailing Address - Country:US
Mailing Address - Phone:234-275-1465
Mailing Address - Fax:
Practice Address - Street 1:148 ROOSEVELT ST NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-3327
Practice Address - Country:US
Practice Address - Phone:234-275-1465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602858000924251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care