Provider Demographics
NPI:1124856067
Name:MILLER, MCKENNA NICOLE
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:NICOLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 HAYFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-4290
Mailing Address - Country:US
Mailing Address - Phone:740-602-2341
Mailing Address - Fax:
Practice Address - Street 1:5105 PARKMOOR DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8837
Practice Address - Country:US
Practice Address - Phone:614-519-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker