Provider Demographics
NPI:1285312140
Name:MILLEY, MICHELLE M
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:MILLEY
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 1:690 BLACK OAK DR APT 13
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8334
Mailing Address - Country:US
Mailing Address - Phone:541-646-6265
Mailing Address - Fax:
Practice Address - Street 1:690 BLACK OAK DR APT 13
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8334
Practice Address - Country:US
Practice Address - Phone:541-646-6265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide