Provider Demographics
NPI:1285275917
Name:MILLER, JANE MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40-48 GLANN ROAD
Mailing Address - Street 2:
Mailing Address - City:APALACHIN
Mailing Address - State:NY
Mailing Address - Zip Code:13732-1563
Mailing Address - Country:US
Mailing Address - Phone:607-757-2268
Mailing Address - Fax:607-757-3686
Practice Address - Street 1:3100 KNAPP RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3037
Practice Address - Country:US
Practice Address - Phone:607-757-2268
Practice Address - Fax:607-757-3686
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY421031-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY664318Medicaid