Provider Demographics
NPI:1306158357
Name:MILLER, JESSICA IRENE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:IRENE
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 1:1117 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3403
Mailing Address - Country:US
Mailing Address - Phone:307-797-4535
Mailing Address - Fax:
Practice Address - Street 1:1117 E 5TH ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3403
Practice Address - Country:US
Practice Address - Phone:307-797-4535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator