Provider Demographics
NPI:1285146225
Name:MILLER, MIRIAM
Entity type:Individual
Prefix:
First Name:MIRIAM
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 1:898 MCALLISTER RD.
Mailing Address - Street 2:
Mailing Address - City:TROUPSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14885
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:898 MCALLISTER RD
Practice Address - Street 2:
Practice Address - City:TROUPSBURG
Practice Address - State:NY
Practice Address - Zip Code:14885-9753
Practice Address - Country:US
Practice Address - Phone:607-525-6588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267449-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse