Provider Demographics
NPI:1194251330
Name:MILLER, YVONNE
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
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 1:11107 203RD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2225
Mailing Address - Country:US
Mailing Address - Phone:718-810-6175
Mailing Address - Fax:718-217-5908
Practice Address - Street 1:11107 203RD ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2225
Practice Address - Country:US
Practice Address - Phone:718-810-6175
Practice Address - Fax:718-217-5908
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-09
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist