Provider Demographics
NPI:1104952597
Name:MILLER, JUDITH BARBARA (RN)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:BARBARA
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JUDITH
Other - Middle Name:BARBARA
Other - Last Name:HECKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6339 GLEN CT
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-9112
Mailing Address - Country:US
Mailing Address - Phone:262-629-5389
Mailing Address - Fax:
Practice Address - Street 1:3114 SHERMAN PARC CIRCLE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WI
Practice Address - Zip Code:53037
Practice Address - Country:US
Practice Address - Phone:262-677-8521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI80525030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39833500Medicaid