Provider Demographics
NPI:1225871049
Name:DEDIC-MILLER, KORANA L
Entity type:Individual
Prefix:
First Name:KORANA
Middle Name:L
Last Name:DEDIC-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 1:3950 WASHAKIE ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2394
Mailing Address - Country:US
Mailing Address - Phone:307-262-4804
Mailing Address - Fax:
Practice Address - Street 1:3950 WASHAKIE ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2394
Practice Address - Country:US
Practice Address - Phone:307-262-4804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator