Provider Demographics
NPI:1285943407
Name:MILLER, JEANNE LOUISE (RN)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:LOUISE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50491
Mailing Address - Street 2:
Mailing Address - City:PARKS
Mailing Address - State:AZ
Mailing Address - Zip Code:86018-0491
Mailing Address - Country:US
Mailing Address - Phone:928-635-2285
Mailing Address - Fax:
Practice Address - Street 1:3500 S GILLENWATER DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-9004
Practice Address - Country:US
Practice Address - Phone:928-773-4002
Practice Address - Fax:928-773-4010
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN066860163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool